Pancreatic Enzyme Supplementation Improves the Incretin Hormone Response and Attenuates Postprandial Glycemia in Adolescents With Cystic Fibrosis: A Randomized Crossover Trial

Abstract

In young people with pancreatic insufficient CF, PERT markedly attenuates postprandial hyperglycemia by slowing gastric emptying and augmenting incretin hormone secretion.

Cystic fibrosis related diabetes—a new perspective on the optimal management of postprandial glycemia

“…Pancreatic enzyme supplementation slowed gastric emptying and markedly decreased the postprandial glycaemic excursion ( Fig.1-2) [41]. We recently reported the same phenomenon in a study of 14 paediatric CF patients (Fig.3) [45].…”

“…Despite the potential importance of abnormal gastric emptying in CF patients, only a limited number of studies have evaluated gastric emptying in this population [33,[41][42][43][44][45], with inconsistent results, attributable to differences in subject characteristics, meal composition, use of pancreatic enzymes and the method used to measure gastric emptying. Studies have reported abnormally rapid [41,42] or delayed [44] emptying, or no difference from controls [33,43,45].…”

“…Studies have reported abnormally rapid [41,42] or delayed [44] emptying, or no difference from controls [33,43,45]. A bimodal pattern of gastric emptying has also been proposed, with more rapid emptying 'early' in the disease reflecting gut adaptations to the high energy diet, and delayed emptying 'later', when malnutrition is more likely to be present [42].…”

“…relating to GLP-1 and GIP secretion is limited and conflicting, probably reflecting methodological inconsistencies [41,49]. Our recent work, in both adult and paediatric CF patients, has provided persuasive evidence of a marked reduction in GLP-1 and GIP secretion in response to a high fat/high carbohydrate meal [41,45].…”

“…E, Glucagon concentrations were similar between CF and controls (P = 0.3) and increased with PERT (P < 0.0001). Reprinted from Perano et al [45], with permission.…”