Quantification of the Incretin Effect in Healthy Subjects and Patients With Type 2 Diabetes

NCT ID: NCT00529048

Last Updated: 2009-10-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

16 participants

Study Classification

OBSERVATIONAL

Study Start Date

2007-10-31

Study Completion Date

2009-09-30

Brief Summary

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Patients with T2DM lac a sufficient incretin response after oral glucose intake. It has only been tested using 50g of glucose. We don't know if patients with T2DM are capable of regulating the incretin effect like healthy people in responds to different amounts of glucose intake.

The aim of the present study is to quantify the incretin effect in healthy subjects and in patients with T2DM during increasing amounts of oral glucose challenges. The proposed studies will answer important questions on the mechanisms underlying T2DM and be of importance in relation to future preventive- and treatment strategies.

Detailed Description

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The impaired incretin effect in patients with type 2 diabetes mellitus (T2DM) has previously only been evaluated using a glucose load of 50 g, and it is uncertain whether patients with T2DM are capable of regulating their incretin effect equivalent to healthy subjects. Furthermore, it is of great interest to quantify the secretion of GIP and GLP-1 during increasing glucose loads in both patients with T2DM and in healthy subjects in order to evaluate whether an increased secretion of one or both of the two incretin hormones contributes to the regulation of the incretin effect.

The aim of the present study is to quantify the incretin effect in healthy subjects and in patients with T2DM during increasing amounts of oral glucose challenges and corresponding isoglycemic iv glucose challenges. The proposed studies will answer important questions on the pathophysiology underlying T2DM and be of importance in relation to future preventive- and treatment strategies.

Eight patients with T2DM and 8 matched healthy subjects will be evaluated with oral glucose tolerance tests (OGTT) using increasing glucose loads (25, 50 and 100 g glucose) and isoglycemic iv glucose tolerance tests imitating the glucose concentrations as obtained during the oral glucose loads. The results will describe the regulation of the incretin effect in patients with T2DM and, thereby, contribute to the clarification of the pathophysiology of the postprandial hyperglycemia characterizing these patients.

Conditions

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Incretin Effect

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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T2DM

T2DM patients (WHO-criteria)

Oral Glucose Tolerance Test

Intervention Type OTHER

The test is preformed 3 times with 3 different amounts of glucose (25g, 75g and 125g) deluded in 300ml of water.

Isoglycemic clamp

Intervention Type OTHER

I.v. glucose infusion initiating the glucose responds curves from the OGTT

Gastric emptying rate

Intervention Type OTHER

Paracetamol absorption test. Intake of 1,5g of paracetamol followed by measuring the absorption curve

CTRL

Healthy control subjects matched individually to the cases.

Oral Glucose Tolerance Test

Intervention Type OTHER

The test is preformed 3 times with 3 different amounts of glucose (25g, 75g and 125g) deluded in 300ml of water.

Isoglycemic clamp

Intervention Type OTHER

I.v. glucose infusion initiating the glucose responds curves from the OGTT

Gastric emptying rate

Intervention Type OTHER

Paracetamol absorption test. Intake of 1,5g of paracetamol followed by measuring the absorption curve

Interventions

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Oral Glucose Tolerance Test

The test is preformed 3 times with 3 different amounts of glucose (25g, 75g and 125g) deluded in 300ml of water.

Intervention Type OTHER

Isoglycemic clamp

I.v. glucose infusion initiating the glucose responds curves from the OGTT

Intervention Type OTHER

Gastric emptying rate

Paracetamol absorption test. Intake of 1,5g of paracetamol followed by measuring the absorption curve

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Caucasians with T2DM according to WHO's criteria
* Normal Hemoglobin
* Agree to participate (orally and in writing)
* HbA1c: 6.5-9 %
* BMI: 23-35 kg/m2


* Caucasians
* Normal oral glucose tolerance according to WHO's criteria
* Normal Hemoglobin
* Agree to participate (orally and in writing)
* BMI: 23-35 kg/m2

Exclusion Criteria

* Liver disease (ALAT \> 2 x normal level)
* Diabetic nephropathy (s-creatinin \> 130 µM or albuminuria)
* Diabetic neuropathy (anamnestic)
* Proliferative diabetic retinopathy (anamnestic)
* Medical treatment witch cannot be stopped for 12 hours
* Pregnancy or breastfeed
* Treatment with Insulin or glitazones


* Liver disease (ALAT \> 2 x normal level)
* Impaired function of the kidney (s-creatinin \> 130 µM or albuminuria)
* Directly related til to someone suffering from diabetes mellitus
* Medical treatment witch cannot be stopped for 12 hours
* Pregnancy or breastfeed
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Copenhagen

OTHER

Sponsor Role collaborator

Merck Sharp & Dohme LLC

INDUSTRY

Sponsor Role collaborator

Forskningsrådet

UNKNOWN

Sponsor Role collaborator

Diabetesforeningen

OTHER

Sponsor Role collaborator

Herlev Hospital

OTHER

Sponsor Role lead

Responsible Party

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University of Copehagen

Principal Investigators

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Tina Villsbøll, MD.DMSc.

Role: STUDY_CHAIR

Herlev Hospital

Filip K Knop, MD.Phd.

Role: STUDY_DIRECTOR

Herlev Hospital

Locations

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Endokrinologisk afd. J, Herlev Hospital

Herlev, Capital Region, Denmark

Site Status

Countries

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Denmark

References

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Kolligs F, Fehmann HC, Goke R, Goke B. Reduction of the incretin effect in rats by the glucagon-like peptide 1 receptor antagonist exendin (9-39) amide. Diabetes. 1995 Jan;44(1):16-9. doi: 10.2337/diab.44.1.16.

Reference Type BACKGROUND
PMID: 7813808 (View on PubMed)

Tseng CC, Zhang XY, Wolfe MM. Effect of GIP and GLP-1 antagonists on insulin release in the rat. Am J Physiol. 1999 Jun;276(6):E1049-54. doi: 10.1152/ajpendo.1999.276.6.E1049.

Reference Type BACKGROUND
PMID: 10362617 (View on PubMed)

Wang Z, Wang RM, Owji AA, Smith DM, Ghatei MA, Bloom SR. Glucagon-like peptide-1 is a physiological incretin in rat. J Clin Invest. 1995 Jan;95(1):417-21. doi: 10.1172/JCI117671.

Reference Type BACKGROUND
PMID: 7814643 (View on PubMed)

Habener JF. The incretin notion and its relevance to diabetes. Endocrinol Metab Clin North Am. 1993 Dec;22(4):775-94.

Reference Type BACKGROUND
PMID: 8125072 (View on PubMed)

Edwards CM, Todd JF, Mahmoudi M, Wang Z, Wang RM, Ghatei MA, Bloom SR. Glucagon-like peptide 1 has a physiological role in the control of postprandial glucose in humans: studies with the antagonist exendin 9-39. Diabetes. 1999 Jan;48(1):86-93. doi: 10.2337/diabetes.48.1.86.

Reference Type BACKGROUND
PMID: 9892226 (View on PubMed)

Gault VA, O'Harte FP, Harriott P, Mooney MH, Green BD, Flatt PR. Effects of the novel (Pro3)GIP antagonist and exendin(9-39)amide on GIP- and GLP-1-induced cyclic AMP generation, insulin secretion and postprandial insulin release in obese diabetic (ob/ob) mice: evidence that GIP is the major physiological incretin. Diabetologia. 2003 Feb;46(2):222-30. doi: 10.1007/s00125-002-1028-x. Epub 2003 Feb 12.

Reference Type BACKGROUND
PMID: 12627321 (View on PubMed)

Miyawaki K, Yamada Y, Yano H, Niwa H, Ban N, Ihara Y, Kubota A, Fujimoto S, Kajikawa M, Kuroe A, Tsuda K, Hashimoto H, Yamashita T, Jomori T, Tashiro F, Miyazaki J, Seino Y. Glucose intolerance caused by a defect in the entero-insular axis: a study in gastric inhibitory polypeptide receptor knockout mice. Proc Natl Acad Sci U S A. 1999 Dec 21;96(26):14843-7. doi: 10.1073/pnas.96.26.14843.

Reference Type BACKGROUND
PMID: 10611300 (View on PubMed)

Scrocchi LA, Brown TJ, MaClusky N, Brubaker PL, Auerbach AB, Joyner AL, Drucker DJ. Glucose intolerance but normal satiety in mice with a null mutation in the glucagon-like peptide 1 receptor gene. Nat Med. 1996 Nov;2(11):1254-8. doi: 10.1038/nm1196-1254.

Reference Type BACKGROUND
PMID: 8898756 (View on PubMed)

Nauck M, Stockmann F, Ebert R, Creutzfeldt W. Reduced incretin effect in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1986 Jan;29(1):46-52. doi: 10.1007/BF02427280.

Reference Type BACKGROUND
PMID: 3514343 (View on PubMed)

Vilsboll T, Krarup T, Madsbad S, Holst JJ. Defective amplification of the late phase insulin response to glucose by GIP in obese Type II diabetic patients. Diabetologia. 2002 Aug;45(8):1111-9. doi: 10.1007/s00125-002-0878-6. Epub 2002 Jul 4.

Reference Type BACKGROUND
PMID: 12189441 (View on PubMed)

Kjems LL, Holst JJ, Volund A, Madsbad S. The influence of GLP-1 on glucose-stimulated insulin secretion: effects on beta-cell sensitivity in type 2 and nondiabetic subjects. Diabetes. 2003 Feb;52(2):380-6. doi: 10.2337/diabetes.52.2.380.

Reference Type BACKGROUND
PMID: 12540611 (View on PubMed)

Nauck MA, Homberger E, Siegel EG, Allen RC, Eaton RP, Ebert R, Creutzfeldt W. Incretin effects of increasing glucose loads in man calculated from venous insulin and C-peptide responses. J Clin Endocrinol Metab. 1986 Aug;63(2):492-8. doi: 10.1210/jcem-63-2-492.

Reference Type BACKGROUND
PMID: 3522621 (View on PubMed)

Vilsboll T, Krarup T, Madsbad S, Holst JJ. Both GLP-1 and GIP are insulinotropic at basal and postprandial glucose levels and contribute nearly equally to the incretin effect of a meal in healthy subjects. Regul Pept. 2003 Jul 15;114(2-3):115-21. doi: 10.1016/s0167-0115(03)00111-3.

Reference Type BACKGROUND
PMID: 12832099 (View on PubMed)

Bagger JI, Knop FK, Lund A, Holst JJ, Vilsboll T. Glucagon responses to increasing oral loads of glucose and corresponding isoglycaemic intravenous glucose infusions in patients with type 2 diabetes and healthy individuals. Diabetologia. 2014 Aug;57(8):1720-5. doi: 10.1007/s00125-014-3264-2. Epub 2014 May 31.

Reference Type DERIVED
PMID: 24879388 (View on PubMed)

Bagger JI, Knop FK, Lund A, Vestergaard H, Holst JJ, Vilsboll T. Impaired regulation of the incretin effect in patients with type 2 diabetes. J Clin Endocrinol Metab. 2011 Mar;96(3):737-45. doi: 10.1210/jc.2010-2435. Epub 2011 Jan 20.

Reference Type DERIVED
PMID: 21252240 (View on PubMed)

Other Identifiers

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INK-GLUKOSE1

Identifier Type: -

Identifier Source: org_study_id

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