Shift of Glucose Peak Time During Oral Glucose Tolerance Test is Associated with Changes in Insulin Secretion and Insulin Sensitivity After Therapy with Antidiabetic Drugs in Patients with Type 2 Diabetes

Abstract

Introduction: Delay in peak blood glucose during an oral glucose tolerance test (OGTT) predicts declining b-cell function and poor ability to regulate glucose metabolism. Glucose peak time has not been used as a comparative indicator of the improvement in islet function after treatment with exenatide, insulin, or oral antidiabetic drugs (OADs). We evaluated the efficacy of three types of antidiabetic drugs on the basis of blood glucose peak time in patients with non-newly diagnosed type 2 diabetes. Methods: The data from 100 patients with diabetes who completed two OGTTs within 6 months were collected. Thirty-seven of them with type 2 diabetes were treated with Humalog Mix25, 28 patients with OADs (metformin, acarbose, and gliclazide), and 35 patients with exenatide. Results: Glycated hemoglobin improved in all three groups after treatment (P \ 0.05). Subcutaneous adipose tissue (P \ 0.01) and visceral adipose tissue (P \ 0.0001) significantly decreased in the exenatide group. The insulinogenic index (IGI) (P = 0.01) and IGI 9 oral glucose insulin sensitivity (OGIS) (P = 0.01) improved in the exenatide group only. Homeostatic assessment of b-cell function (HOMA-b) and OGIS were greater in the exenatide and OAD groups than in the Humalog Mix25 group (all P \ 0.05). A shift to an earlier peak was observed in 57.1%, 35.7%, and 27.0% of patients in the exenatide, OAD, and Humalog Mix25 groups, respectively (P = 0.029). OGIS (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.33-0.89, P = 0.026) and IGI 9 OGIS (OR 1.72, 95% CI 0.44-6.68, P = 0.012) were independently related to shifts in glucose peak time. Conclusion: Exenatide, Humalog Mix25, and OADs improved glycemic metabolism. However, exenatide exhibited superior efficacy in shifting blood glucose peak time to an earlier point, while it improved insulin secretion and insulin sensitivity. Hence, the shift of glucose peak time may be considered an indicator for the evaluation of the effect of hypoglycemic drugs.

Control glucémico en pacientes con diabetes mellitus tipo 2 según esquema de tratamiento

“…El promedio de HbA1c encontrado en pacientes con monoterapia en comparación con diferentes estudios de tratamiento fueron los siguientes: con iD-PP-4 se observa mayor en comparación con lo que encontraron Gilbert y Pratley 23 , y en cambio, con GLP-1, se observó menos que estos autores. En los pacientes tratados con insulina Mix25 se encontró un mayor control que lo reportado por Jiang et al 24 con la misma insulina. Con la sulfonilurea glibenclamida vemos en nuestra población igual que Hematyar et al 25 , y con dapagliflozina mayor que lo encontrado por Scorsone et al 26 en su estudio.…”

Modulation of 1,2-Dicarbonyl Compounds in Postprandial Responses Mediated by Food Bioactive Components and Mediterranean Diet

“…Whereas a high variability in the glycemic peak time after glucose intake has been reported for diabetic subjects, ranging from 60 to 150 min postprandial [ 36 , 37 ]. The lag time in the glycemic peak observed among type 2 diabetic subjects has been associated with pancreatic β-cell dysfunction [ 36 , 38 , 39 ]. A wide range of postprandial methylglyoxal peak times (from 30 to 120 min) have been reported among different studies, but also within the same studies with subjects with different impairment degrees in the glucose metabolism ( Table 1 ).…”

An effective ultra‐performance liquid chromatography and derivatization method for the quantification of potential genotoxic impurity Hydrazine in Gliclazide and its formulation – Robustness study by the design of experiments

“…Sulfonylureas increase basal insulin secretion and meal-stimulated insulin release [11,12]. Reported F I G U R E 1 Chemical Structures of Gliclazide (GLZ) and Hydrazine (HNE) hydrate additional beneficial pharmacological properties of GLZ, including immunomodulatory and anticoagulant activities, suggested its potential application in treating type 1 diabetes mellitus [13,14]. It is an oral anti-hyperglycemic agent used to treat non-insulin-dependent diabetes mellitus and may have the additional advantage of potentially slowing the progression of diabetic retinopathy [15].…”