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Diabetologia

, Volume 57, Issue 8, pp 1720–1725 | Cite as

Glucagon responses to increasing oral loads of glucose and corresponding isoglycaemic intravenous glucose infusions in patients with type 2 diabetes and healthy individuals

  • Jonatan I. Bagger
  • Filip K. KnopEmail author
  • Asger Lund
  • Jens J. Holst
  • Tina Vilsbøll
Article

Abstract

Aims/hypothesis

Type 2 diabetes is associated with hypersecretion of glucagon during an OGTT, whereas i.v. glucose suppresses glucagon levels. This suggests that type 2 diabetic hyperglucagonaemia may result from glucose stimulation of the gastrointestinal tract. We evaluated glucagon responses to increasing amounts of glucose given orally and corresponding isoglycaemic i.v. glucose infusions (IIGIs) in patients with type 2 diabetes and in healthy controls.

Methods

Plasma glucagon responses were measured during three 4 h OGTTs with increasing loads of glucose (25 g, 75 g and 125 g) and three corresponding IIGIs in eight patients with type 2 diabetes (age [mean ± SEM] 57 ± 4 years; BMI 29.5 ± 1.0 kg/m2; HbA1c 7.0 ± 0.3% [53 ± 2 mmol/mol]) and eight healthy individuals (age 57 ± 4 years; BMI 28.9 ± 0.7 kg/m2; HbA1c 5.4 ± 0.1% [36 ± 1 mmol/mol]).

Results

In healthy controls no difference in glucagon suppression during the first 45 min of the 25 g OGTT and the corresponding IIGI (−153 ± 35 vs −133 ± 24 min × pmol/l; p = NS) was observed, whereas patients with type 2 diabetes only exhibited significant glucagon suppression following IIGI (29 ± 27 vs −144 ± 20 min × pmol/l; p = 0.005). At higher oral glucose loads this difference increased and also became evident in healthy controls.

Conclusions/interpretation

In patients with type 2 diabetes increasing amounts of oral glucose elicit hypersecretion of glucagon, whereas corresponding IIGIs result in significant glucagon suppression; a phenomenon that is also observed in healthy individuals when larger glucose loads are ingested orally. This suggests that the hyperglucagonaemic response to oral glucose in type 2 diabetes may represent a pathological version of a gut-derived physiological phenomenon.

Trial registration: ClinicalTrials.gov NCT00529048

Keywords

Glucagon Glucose Intravenous i.v. Oral Type 2 diabetes 

Abbreviations

GIP

Glucose-dependent insulinotropic polypeptide

GLP

Glucagon-like peptide

iAUC

Incremental AUC

IIGI

Isoglycaemic i.v. glucose infusion

PC1/3

Prohormone convertase 1/3

PC2

Prohormone convertase 2

rmANOVA

Repeated measures ANOVA

Notes

Acknowledgements

We are grateful to our volunteers whose availability made this work possible and to laboratory technician L. Bagger (University of Copenhagen, Copenhagen, Denmark) for measurement of plasma glucagon concentrations. Some of the data were presented as abstracts at the scientific sessions of the American Diabetes Association in 2009 (New Orleans, LA, USA) and at the Annual Scientific Meeting of the European Association for the Study of Diabetes in 2009 (Vienna, Austria).

Funding

The study was supported by an unrestricted research grant (no. 34851) from the Investigator-Initiated Studies Program of Merck & Co. Inc. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck & Co. Inc. The funding source had no involvement in the study design; in the collection, analysis or interpretation of the data; or in the decision to submit the paper for publication. The study was presented in 2011 at the American Diabetes Association 69th Scientific Session (abstract P-1421).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

All the persons listed as authors fulfil all three of the following criteria: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. F. K. Knop is responsible for the integrity of the work as a whole and is the guarantor of this work.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jonatan I. Bagger
    • 1
    • 2
    • 3
  • Filip K. Knop
    • 1
    • 2
    Email author
  • Asger Lund
    • 1
    • 2
  • Jens J. Holst
    • 1
    • 2
  • Tina Vilsbøll
    • 1
    • 2
  1. 1.Center for Diabetes Research, Department of Medicine, Gentofte HospitalUniversity of CopenhagenHellerupDenmark
  2. 2.NNF Center for Basic Metabolic Research, Department of Biomedical Sciences, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Medicine, Herlev HospitalUniversity of CopenhagenHerlevDenmark

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