Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis: A randomized crossover trial

Shiree J. Perano, Jennifer J. Couper, Michael Horowitz, A. James Martin, Stamatiki Kritas, Thomas Sullivan, Chris K. Rayner

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Context: Cystic fibrosis-related diabetes is characterized by postprandial, rather than fasting, hyperglycemia. Gastric emptying and the release of the incretin hormones [glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP)] are central to postprandial glycemic control. Lipolysis is required for fat to slow gastric emptying and stimulate incretin release. Objective: We aimed to determine the effect of pancreatic enzyme replacement therapy (PERT) on postprandial glycemia in adolescents with cystic fibrosis (CF).l2;&-2q Design: This was a double-blinded randomized crossover trial. Subjects consumed a high-fat pancake, with either PERT (50 000 IU lipase) or placebo. Gastric emptying was measured by a breath test and blood sampled frequently for plasma blood glucose, insulin, glucagon, GLP-1, and GIP. Data were also compared with seven healthy subjects. Participants: Fourteen adolescents (13.1 ± 2.7 y) with pancreatic-insufficient CF and seven healthy age-matched controls participated in the study. Main Outcome Measure: Postprandial hyperglycemia was measured as peak glucose and area under the curve for blood glucose at 240 minutes. Results: CF subjects had postprandial hyperglycemia compared with controls (area under the curve, P < .0001). PERT reduced postprandial hyperglycemia (P = .0002), slowed gastric emptying (P = .003), and normalized GLP-1 and GIP secretion (P < .001 for each) when compared with placebo, without affecting insulin. Conclusion: In young people with pancreatic insufficient CF, PERT markedly attenuates postprandial hyperglycemia by slowing gastric emptying and augmenting incretin hormone secretion.

LanguageEnglish
Pages2486-2493
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number7
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Perano, Shiree J. ; Couper, Jennifer J. ; Horowitz, Michael ; Martin, A. James ; Kritas, Stamatiki ; Sullivan, Thomas ; Rayner, Chris K. / Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis : A randomized crossover trial. In: Journal of Clinical Endocrinology and Metabolism. 2014 ; Vol. 99, No. 7. pp. 2486-2493.
@article{0a978711bb3d433bb2ab7cb134caedca,
title = "Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis: A randomized crossover trial",
abstract = "Context: Cystic fibrosis-related diabetes is characterized by postprandial, rather than fasting, hyperglycemia. Gastric emptying and the release of the incretin hormones [glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP)] are central to postprandial glycemic control. Lipolysis is required for fat to slow gastric emptying and stimulate incretin release. Objective: We aimed to determine the effect of pancreatic enzyme replacement therapy (PERT) on postprandial glycemia in adolescents with cystic fibrosis (CF).l2;&-2q Design: This was a double-blinded randomized crossover trial. Subjects consumed a high-fat pancake, with either PERT (50 000 IU lipase) or placebo. Gastric emptying was measured by a breath test and blood sampled frequently for plasma blood glucose, insulin, glucagon, GLP-1, and GIP. Data were also compared with seven healthy subjects. Participants: Fourteen adolescents (13.1 ± 2.7 y) with pancreatic-insufficient CF and seven healthy age-matched controls participated in the study. Main Outcome Measure: Postprandial hyperglycemia was measured as peak glucose and area under the curve for blood glucose at 240 minutes. Results: CF subjects had postprandial hyperglycemia compared with controls (area under the curve, P < .0001). PERT reduced postprandial hyperglycemia (P = .0002), slowed gastric emptying (P = .003), and normalized GLP-1 and GIP secretion (P < .001 for each) when compared with placebo, without affecting insulin. Conclusion: In young people with pancreatic insufficient CF, PERT markedly attenuates postprandial hyperglycemia by slowing gastric emptying and augmenting incretin hormone secretion.",
author = "Perano, {Shiree J.} and Couper, {Jennifer J.} and Michael Horowitz and Martin, {A. James} and Stamatiki Kritas and Thomas Sullivan and Rayner, {Chris K.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1210/jc.2013-4417",
language = "English",
volume = "99",
pages = "2486--2493",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "7",

}

Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis : A randomized crossover trial. / Perano, Shiree J.; Couper, Jennifer J.; Horowitz, Michael; Martin, A. James; Kritas, Stamatiki; Sullivan, Thomas; Rayner, Chris K.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 7, 01.01.2014, p. 2486-2493.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis

T2 - Journal of Clinical Endocrinology and Metabolism

AU - Perano, Shiree J.

AU - Couper, Jennifer J.

AU - Horowitz, Michael

AU - Martin, A. James

AU - Kritas, Stamatiki

AU - Sullivan, Thomas

AU - Rayner, Chris K.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Context: Cystic fibrosis-related diabetes is characterized by postprandial, rather than fasting, hyperglycemia. Gastric emptying and the release of the incretin hormones [glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP)] are central to postprandial glycemic control. Lipolysis is required for fat to slow gastric emptying and stimulate incretin release. Objective: We aimed to determine the effect of pancreatic enzyme replacement therapy (PERT) on postprandial glycemia in adolescents with cystic fibrosis (CF).l2;&-2q Design: This was a double-blinded randomized crossover trial. Subjects consumed a high-fat pancake, with either PERT (50 000 IU lipase) or placebo. Gastric emptying was measured by a breath test and blood sampled frequently for plasma blood glucose, insulin, glucagon, GLP-1, and GIP. Data were also compared with seven healthy subjects. Participants: Fourteen adolescents (13.1 ± 2.7 y) with pancreatic-insufficient CF and seven healthy age-matched controls participated in the study. Main Outcome Measure: Postprandial hyperglycemia was measured as peak glucose and area under the curve for blood glucose at 240 minutes. Results: CF subjects had postprandial hyperglycemia compared with controls (area under the curve, P < .0001). PERT reduced postprandial hyperglycemia (P = .0002), slowed gastric emptying (P = .003), and normalized GLP-1 and GIP secretion (P < .001 for each) when compared with placebo, without affecting insulin. Conclusion: In young people with pancreatic insufficient CF, PERT markedly attenuates postprandial hyperglycemia by slowing gastric emptying and augmenting incretin hormone secretion.

AB - Context: Cystic fibrosis-related diabetes is characterized by postprandial, rather than fasting, hyperglycemia. Gastric emptying and the release of the incretin hormones [glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP)] are central to postprandial glycemic control. Lipolysis is required for fat to slow gastric emptying and stimulate incretin release. Objective: We aimed to determine the effect of pancreatic enzyme replacement therapy (PERT) on postprandial glycemia in adolescents with cystic fibrosis (CF).l2;&-2q Design: This was a double-blinded randomized crossover trial. Subjects consumed a high-fat pancake, with either PERT (50 000 IU lipase) or placebo. Gastric emptying was measured by a breath test and blood sampled frequently for plasma blood glucose, insulin, glucagon, GLP-1, and GIP. Data were also compared with seven healthy subjects. Participants: Fourteen adolescents (13.1 ± 2.7 y) with pancreatic-insufficient CF and seven healthy age-matched controls participated in the study. Main Outcome Measure: Postprandial hyperglycemia was measured as peak glucose and area under the curve for blood glucose at 240 minutes. Results: CF subjects had postprandial hyperglycemia compared with controls (area under the curve, P < .0001). PERT reduced postprandial hyperglycemia (P = .0002), slowed gastric emptying (P = .003), and normalized GLP-1 and GIP secretion (P < .001 for each) when compared with placebo, without affecting insulin. Conclusion: In young people with pancreatic insufficient CF, PERT markedly attenuates postprandial hyperglycemia by slowing gastric emptying and augmenting incretin hormone secretion.

UR - http://www.scopus.com/inward/record.url?scp=84904052278&partnerID=8YFLogxK

U2 - 10.1210/jc.2013-4417

DO - 10.1210/jc.2013-4417

M3 - Article

VL - 99

SP - 2486

EP - 2493

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 7

ER -