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Type: Journal article
Title: Gastric emptying, incretin hormone secretion, and postprandial glycemia in cystic fibrosis - Effects of pancreatic enzyme supplementation
Author: Kuo, P.
Stevens, J.
Russo, A.
Maddox, A.
Wishart, J.
Jones, K.
Greville, H.
Hetzel, D.
Chapman, I.
Horowitz, M.
Rayner, C.
Citation: Journal of Clinical Endocrinology and Metabolism, 2011; 96(5):E851-E855
Publisher: Endocrine Society
Issue Date: 2011
ISSN: 0021-972X
Statement of
Paul Kuo, Julie E. Stevens, Antonietta Russo, Anne Maddox, Judith M. Wishart, Karen L. Jones, Hugh Greville, David Hetzel, Ian Chapman, Michael Horowitz, and Christopher K. Rayner
Abstract: Context: Postprandial hyperglycemia is an important clinical problem in cystic fibrosis (CF), but the contribution of fat malabsorption, rapid gastric emptying, and the incretin axis has not been widely considered. Objective: The aim of this study was to evaluate these aspects of gut function in nondiabetic CF patients. Design and Setting: We conducted a randomized, double-blind, placebo-controlled crossover study at a clinical research laboratory. Patients: Five nondiabetic CF patients (three males; age, 25.8 ± 1.0 yr; body mass index, 20.2 ± 1.1 kg/m2) with exocrine pancreatic insufficiency and six healthy subjects of similar age and body mass index participated in the study. Interventions: CF patients consumed a radiolabeled mashed potato meal on 2 separate days, together with four capsules of Creon Forte (100,000 IU lipase) or placebo. Healthy subjects consumed the meal once, without pancreatic enzymes. Main Outcome Measures: Gastric emptying was measured using scintigraphy, and blood was sampled frequently for blood glucose and plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon concentrations. Results: CF patients had more rapid gastric emptying (P < 0.001), impaired secretion of GLP-1 (P < 0.01) and GIP (P < 0.001), and greater postprandial glycemic excursions (P < 0.001) than healthy subjects. Pancreatic enzyme supplementation normalized gastric emptying and GLP-1 secretion and tended to increase glucagon (P = 0.08), but did not completely restore GIP secretion or normalize postprandial blood glucose. There was an excellent correlation between gastric emptying and blood glucose concentration at 60 min (R = 0.75; P = 0.01). Conclusions: Pancreatic enzyme supplementation plays an important role in incretin secretion, gastric emptying, and postprandial hyperglycemia in CF.
Keywords: Pancreas; Humans; Cystic Fibrosis; Hyperglycemia; Gastric Inhibitory Polypeptide; Glucagon; Insulin; Lipase; Dietary Carbohydrates; Blood Glucose; Dietary Fats; Double-Blind Method; Gastric Emptying; Adult; Female; Male; Glucagon-Like Peptide 1; Incretins; Young Adult
Rights: Copyright © 2011 by The Endocrine Society
RMID: 0020107334
DOI: 10.1210/jc.2010-2460
Appears in Collections:Medicine publications

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