Exogenous glucose-dependent insulinotropic polypeptide worsens postprandial hyperglycemia in type 2 diabetes

Chee W. Chia, Olga D. Carlson, Wook Kim, Yu Kyong Shin, Cornelia P. Charles, Seung Kim Hee, Denise L. Melvin, Josephine M. Egan

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE - Glucose-dependent insulinotropic polypeptide (GIP), unlike glucagon-like peptide (GLP)-1, lacks glucose-lowering properties in patients with type 2 diabetes. We designed this study to elucidate the underlying pathophysiology. RESEARCH DESIGN AND METHODS - Twenty-two insulin-naïve subjects with type 2 diabetes were given either synthetic human GIP (20 ng·kg-1·min-1) or placebo (normal saline) over 180 min, starting with the first bite of a mixed meal (plus 1 g of acetaminophen) on two separate occasions. Frequent blood samples were obtained over 6 h to determine plasma GIP, GLP-1, glucose, insulin, glucagon, resistin, and acetaminophen levels. RESULTS - Compared with placebo, GIP induced an early postprandial increase in insulin levels. Intriguingly, GIP also induced an early postprandial augmentation in glucagon, a significant elevation in late postprandial glucose, and a decrease in late postprandial GLP-1 levels. Resistin and acetaminophen levels were comparable in both interventions. By immunocytochemistry, GIP receptors were present on human and mouse α-cells. In αTC1 cell line, GIP induced an increase in intracellular cAMP and glucagon secretion. CONCLUSIONS - GIP, given to achieve supraphysiological plasma levels, still had an early, short-lived insulinotropic effect in type 2 diabetes. However, with a concomitant increase in glucagon, the glucose-lowering effect was lost. GIP infusion further worsened hyperglycemia postprandially, most likely through its suppressive effect on GLP-1. These findings make it unlikely that GIP or GIP receptor agonists will be useful in treating the hyperglycemia of patients with type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)1342-1349
Number of pages8
JournalDiabetes
Volume58
Issue number6
DOIs
StatePublished - Jun 2009

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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