The Effects of Macronutrients Composition on Hormones and Substrates During a Meal Tolerance Test in Drugnaive and Sitagliptin-treated Individuals with Type 2 Diabetes: a Randomized Crossover Study

Overview

Journal Arch Endocrinol Metab

Specialty Endocrinology

Date 2022 May 13

PMID 35551683

Authors

Cristina da Silva Schreiber

Alex Rafacho

Renata Silverio

Roberto Betti

Antonio Carlos Lerario

Ana Maria Pita Lotenberg

Klara Rahmann

Carolina Piras de Oliveira

Bernardo Leo Wajchenberg

Protasio Lemos Da Luz

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT).

Methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis.

Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels.

Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543.

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