Impact of variations in duodenal glucose load on insulin clearance in health and type 2 diabetes
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Up to 70% of secreted insulin is degraded or cleared prior to entering the systemic circulation, primarily in the liver which represents an important mechanism in the regulation of glucose homeostasis . Insulin clearance is known to be reduced following oral, compared with intravenous, glucose administration; however, the mechanism is incompletely understood. Variations in insulin clearance may contribute to the ‘incretin’ effect (IE), which accounts for 50–70% of postprandial insulin release in health and is markedly reduced in type 2 diabetes (T2D). Hence, the incretin effect reflects not only an amplified insulin secretory response (ISR), but also reduced insulin clearance, to oral compared with isoglycemic intravenous glucose .
After the meal, the stomach regulates the delivery of chyme to the small intestine, at a rate that exhibits wide inter-individual variation—between 1 and 4 kcal/min in health, with an even wider range in diabetes, where patients often have...
Funding was provided by the National Health and Medical Research Council, Australia (Grant No. 627139).
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Conflict of interest
The authors declare that they have no conflict of interest.