TFor patients with type 2 diabetes taking metformin
monotherapy, the bile acid sequestrant colesevelam
reduces fasting and postprandial glucose
concentrations without any effects on insulin
concentration, secretion, or action, according to
research published online Dec. 18 in Diabetes.
Galina Smushkin, M.D., of the Mayo Clinic College of
Medicine in Rochester, Minn., and colleagues
conducted a double-blind, placebo-controlled,
parallel-group study of the effect of bile acid
sequestration with colesevelam on glucose metabolism
in 38 patients with type 2 diabetes who were taking
metformin monotherapy.
To measure the rate of meal appearance, endogenous
glucose production, and glucose disappearance,
participants underwent testing before and after 12
weeks of colesevelam or placebo using a labeled
triple-tracer mixed meal.
The researchers found that colesevelam treatment
correlated with significantly lower fasting and
postprandial glucose concentrations, without any
change in insulin concentration, secretion, or
action. Colesevelam treatment was not associated
with changes in postprandial concentrations of
glucagon-like peptide-1 (GLP-1). colesevelam was
associated with no change in endogenous glucose
production and glucose disappearance but was linked
to a decrease in the rate of meal appearance.
"In this experiment, we demonstrate an effect of
colesevelam on both fasting and postprandial glucose
concentrations," the authors write. "Measurement of
insulin secretion and action using the oral labeled
and unlabeled minimal model failed to show a
significant effect on insulin secretion and action.
Moreover, there was no evidence that glucose
lowering is produced by alterations in GLP-1
concentrations." Daiichi-Sankyo provided grant
support for the study; one author disclosed
financial ties to pharmaceutical companies,
including Daiichi-Sankyo, which markets colesevelam.
For more information
The Effect of a Bile Acid Sequestrant on Glucose
Metabolism in Subjects With Type 2 Diabetes
http://diabetes.diabetesjournals.org/content/early/2012/12/17/db12-0923.abstract
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