Effects of vildagliptin and/or a whey preload on postprandial glycaemia in patients with type 2 diabetes using metformin — ASN Events
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Effects of vildagliptin and/or a whey preload on postprandial glycaemia in patients with type 2 diabetes using metformin (#259)

Tongzhi Wu 1 2 , Tanya J Little 1 2 , Michelle J Bound 1 2 , Malcolm Borg 1 2 , Xiang Zhang 1 2 , Carolyn F Deacon 3 , Michael Horowitz 1 2 , Karen L Jones 1 2 , Christopher K Rayner 1 2
  1. Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
  2. Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
  3. Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark

Aims: Nutrient ‘preloads’ given before meals can attenuate postprandial glycaemic excursions in type 2 diabetes, at least in part by slowing gastric emptying (GE) and stimulating glucagon-like peptide-1 (GLP-1) secretion, and may, accordingly, improve the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors. We have evaluated the effects of vildagliptin and/or a low dose of whey protein on GE and postprandial glycaemia in metformin-treated patients with type 2 diabetes.

Methods: 22 patients with type 2 diabetes, managed by metformin monotherapy (stable dose ≥500mg/day for ≥3 months), were each studied on four occasions in double-blind, randomised fashion. Subjects took either 50mg vildagliptin or placebo on both the preceding evening (~1900h) and the morning (~0730h) of each study day. The latter was followed 60min later (~0830h) by a 250mL preload drink, containing either 25g whey protein (89kcal) or control flavouring (8kcal) (ie. the four treatments were vildagliptin + whey (VW), vildagliptin + control (VC), placebo + whey (PW), and placebo + control (PC)). 30min later, they ate a mashed potato meal labelled with 100μg 13C-octanoic acid. Blood glucose and GE (breath test) were evaluated over 240min. Data are mean ± SEM.

Results: Fasting blood glucose did not differ between the whey and control study days, but was slightly lower with vildagliptin (P=0.003). After the meal, both the peak and area under the curve (AUC) for blood glucose were lower with VC compared with PC (P<0.01 for each), and were lowest with VW (P<0.05 for each), without significant differences between PW and PC. GE was slower with PW and VC compared with PC, and was slowest with VW (P<0.01 for each). The magnitude of reduction in peak postprandial glucose with vildagliptin compared with placebo was related directly to the delay in GE (r = 0.42, P=0.005).

Conclusions: In type 2 diabetes managed by metformin monotherapy, combining vildagliptin with a low dose of whey preload is more potent at slowing GE, and this is associated with greater lowering of postprandial glycaemia, than either alone. The reduction in peak postprandial glucose after vildagliptin is, at least partly, related to slowing of GE