Effects of sitagliptin on gastric emptying of, and the glycaemic and blood pressure responses to, a carbohydrate meal in type 2 diabetes

Stevens, Julie E.; Buttfield, Madeline; Wu, Tongzhi; Hatzinikolas, Seva; Pham, Hung; Lange, Kylie; Rayner, Christopher K.; Horowitz, Michael; Jones, Karen L.

doi:10.1111/dom.13864

Cited by 18 publications

(19 citation statements)

References 31 publications

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“…Fascinatingly, although case reports suggest beneficial effects of DPP‐4 inhibitors on PPH, 3,4 the available trials are conflicting. Stevens et al observed no effect on postprandial BP after two doses of sitagliptin 33 . Our own group previously showed that 12 weeks of sitagliptin versus placebo augments the postprandial drop in DBP 2 .…”

Section: Discussionmentioning

confidence: 94%

Effects of dipeptidyl peptidase‐4 inhibitor linagliptin versus sulphonylurea glimepiride on systemic haemodynamics in overweight patients with type 2 diabetes: A secondary analysis of an 8‐week, randomized, controlled, double‐blind trial

Kraaijenhof

Muskiet

Tonneijck

et al. 2020

Diabetes Obesity Metabolism

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Aim To determine the glucose‐independent effect of the dipeptidyl peptidase‐4 (DPP‐4) inhibitor linagliptin versus the sulphonylurea glimepiride on systemic haemodynamics in the fasting and postprandial state in patients with type 2 diabetes (T2D). Materials and Methods In this prespecified secondary analysis of a phase IV, double‐blind trial, 46 metformin‐treated, overweight patients with T2D were included and randomly assigned (1:1) to once‐daily linagliptin (5 mg) or glimepiride (1 mg) for 8 weeks. In a sub‐study involving 26 patients, systemic haemodynamics were also assessed following a standardized liquid meal (Nutridrink Yoghurt style). Systemic haemodynamics (oscillometric device and finger photoplethysmography), arterial stiffness (applanation tonometry) and cardiac sympathovagal balance (heart rate variability [HRV]) were measured in the fasting state and repetitively following the meal. Ewing tests were performed in the fasting state. Results From baseline to week 8, linagliptin compared with glimepiride did not affect systemic haemodynamics, arterial stiffness or HRV in the fasting state. Linagliptin increased parasympathetic nervous activity, as measured by the Valsalva manoeuvre (P = .021) and deep breathing test (P = .027) compared with glimepiride. Postprandially, systolic blood pressure (SBP) dropped an average of 7.6 ± 1.6 mmHg. Linagliptin reduced this decrease to 0.7 ± 2.3 mmHg, which was significant to glimepiride (P = .010). Conclusions When compared with glimepiride, linagliptin does not affect fasting blood pressure. However, linagliptin blunted the postprandial drop in SBP, which could benefit patients with postprandial hypotension.

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Section: Discussionmentioning

confidence: 94%

Effects of dipeptidyl peptidase‐4 inhibitor linagliptin versus sulphonylurea glimepiride on systemic haemodynamics in overweight patients with type 2 diabetes: A secondary analysis of an 8‐week, randomized, controlled, double‐blind trial

Kraaijenhof

Muskiet

Tonneijck

et al. 2020

Diabetes Obesity Metabolism

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“…However, there is a lack of clinical trials on GLP-1 receptor agonists in patients with PPH. In two case reports, DPP-IV inhibitors were found to improve symptoms of dizziness after a meal and decrease blood pressure drop ( 34 , 35 ), but DPP-IV inhibitors showed no difference in gastric emptying and postprandial blood pressure compared with placebo in the new randomized crossover trial ( 36 ), so further research is necessary to confirm the mechanism of the DPP-IV curative effect. Duodenal administration of 1 g of metformin improved the frequency and degree of PPH and delayed gastric emptying in type 2 diabetic patients who were not receiving hypoglycemic medication ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Acarbose for Postprandial Hypotension With Glucose Metabolism Disorders: A Systematic Review and Meta-Analysis

Wang

Zhao

Zhan

et al. 2021

Front. Cardiovasc. Med.

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Background: Postprandial hypotension (PPH) is an independent predictive factor of all-cause mortality in older people. Drug management has not achieved a satisfactory effect yet. In recent years, many studies have found that acarbose may be effective in the treatment of PPH with glucose metabolism disorders.Objective: To assess the efficacy and safety of acarbose on PPH with glucose metabolism disorders.Methods: PubMed (MEDLINE), Cochrane, EMBASE, Web of Science, Clinical Trials, and relevant Chinese databases were searched from inception to October 1, 2020. Randomized controlled studies of acarbose in the treatment of PPH with glucose metabolism disorders were included. Review Manager 5.3 software was used for quality evaluation and meta-analysis. GRADEpro GDT software was used to GRADE the evidence for the research objectives.Results: A total of 4 randomized controlled studies including 202 participants were identified after screening. The meta-analysis showed that acarbose significantly attenuated the decrease in postprandial systolic blood pressure [weighted mean difference (MD): −9.84, 95% CI: −13.34 to −6.33], diastolic blood pressure (MD: −6.86, 95% CI: −12.89 to −0.83), and mean arterial pressure (MD: −8.10, 95% CI: −12.40 to −3.49) compared with the control group. One study reported a case of adverse reactions that included mild abdominal distension in the acarbose group (4.8%, 1/21). No adverse reactions were reported in the other three studies.Conclusion: Acarbose may attenuate the decrease in postprandial blood pressure and avoid the occurrence of PPH in patients with PPH and abnormal glucose metabolism disorders. More clinical trials are needed to make a clear conclusion.Registration: PROSPERO CRD42020171335.

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“…That the reduction in postprandial glycaemia induced by exogenous GLP-1 is associated with less, rather than more, postprandial insulin secretion suggests that the slowing of gastric emptying outweighs its insulinotropic effect in controlling postprandial glycaemia [ 59 ]. In contrast to the GLP-1 receptor agonists, the DPP-4 inhibitors—which prolong the half-life of endogenous GLP-1—have little, if any, effect on gastric emptying [ 60 , 61 ].…”

Section: Secretion and Actions Of Gastrointestinal Hormonesmentioning

confidence: 99%

Enteroendocrine Hormone Secretion and Metabolic Control: Importance of the Region of the Gut Stimulation

et al. 2020

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It is now widely appreciated that gastrointestinal function is central to the regulation of metabolic homeostasis. Following meal ingestion, the delivery of nutrients from the stomach into the small intestine (i.e., gastric emptying) is tightly controlled to optimise their subsequent digestion and absorption. The complex interaction of intraluminal nutrients (and other bioactive compounds, such as bile acids) with the small and large intestine induces the release of an array of gastrointestinal hormones from specialised enteroendocrine cells (EECs) distributed in various regions of the gut, which in turn to regulate gastric emptying, appetite and postprandial glucose metabolism. Stimulation of gastrointestinal hormone secretion, therefore, represents a promising strategy for the management of metabolic disorders, particularly obesity and type 2 diabetes mellitus (T2DM). That EECs are distributed distinctively between the proximal and distal gut suggests that the region of the gut exposed to intraluminal stimuli is of major relevance to the secretion profile of gastrointestinal hormones and associated metabolic responses. This review discusses the process of intestinal digestion and absorption and their impacts on the release of gastrointestinal hormones and the regulation of postprandial metabolism, with an emphasis on the differences between the proximal and distal gut, and implications for the management of obesity and T2DM.

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Effects of sitagliptin on gastric emptying of, and the glycaemic and blood pressure responses to, a carbohydrate meal in type 2 diabetes

Cited by 18 publications

References 31 publications

Effects of dipeptidyl peptidase‐4 inhibitor linagliptin versus sulphonylurea glimepiride on systemic haemodynamics in overweight patients with type 2 diabetes: A secondary analysis of an 8‐week, randomized, controlled, double‐blind trial

Effects of dipeptidyl peptidase‐4 inhibitor linagliptin versus sulphonylurea glimepiride on systemic haemodynamics in overweight patients with type 2 diabetes: A secondary analysis of an 8‐week, randomized, controlled, double‐blind trial

Acarbose for Postprandial Hypotension With Glucose Metabolism Disorders: A Systematic Review and Meta-Analysis

Enteroendocrine Hormone Secretion and Metabolic Control: Importance of the Region of the Gut Stimulation

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