In a nutshell
This study investigated whether taking a protein supplement before a meal could improve the effectiveness of galvus (Vildagliptin) in people with type 2 diabetes (T2D). It found that vildagliptin was more effective when given with a protein ‘preload’.
Some background
Incretins are hormones that are made in the intestines in response to a meal. They encourage the body to make insulin (lowers blood glucose), and prevent the release of glucagon (raises blood glucose). Vildagliptin is a dipeptidyl peptidase-4 (DPP4) inhibitor. DPP4 inhibitors prevent the breakdown of incretins, thus increasing insulin production.
It has been suggested that taking a protein ‘preload’ before a main meal can slow gastric empting (speed of food leaving the stomach) and reduce the rise in blood glucose after a meal. Whether a protein preload can increase incretin levels and improve the effectiveness of DPP4 inhibitors is less certain.
Methods & findings
22 adults with T2D, treated with glucophage (Metformin) only, participated in this study. They were examined once a week for 4 weeks. In the evening before the exam they ate a standard meal with metformin and either vildagliptin or placebo (drug with no active effect). They then fasted until the exam in the morning. During the exam blood samples were taken. The participants took either vildagliptin or placebo, and then a drink containing either protein or a non-protein flavoring. They then had another standard meal.
Fasting blood glucose was lower with vildagliptin than placebo. The protein preload had no effect on fasting blood glucose. After the morning meal participants who had taken both vildagliptin and the protein preload had the lowest rise in blood glucose levels.
After the morning meal insulin levels increased in those who had taken the protein preload. Whether a patient took vildagliptin or placebo did not have a significant effect on insulin levels. Glucagon levels were increased in those who took the protein preload, but were lower in those who took vildagliptin.
Taking the protein preload increased levels of incretins. After the morning meal those who took vildagliptin and the protein preload had the highest levels of incretins. Gastric emptying was slowest in those patients who took both vildagliptin and the protein preload.
The bottom line
The study concluded that a protein preload reduces the rise in glucose levels after a meal, slows gastric emptying, and increases incretin, insulin, and glucagon levels. They also concluded that vildagliptin reduces rise in glucose levels after a meal, slows gastric emptying, increases incretin levels, and reduces glucagon. They determined that combining vildagliptin and the protein preload is more effective than using either alone.
The fine print
This study examined a small number of patients, all of whom were male. Thus the results may not apply equally to all people with T2D. Furthermore, the study was funded by the manufacturers of vildagliptin.
What’s next?
Discuss the effects of protein, and other nutrient, ‘preloads’ on diabetes medications with your physician.
Published By :
Diabetes Care
Date :
Jan 19, 2016
