RT Journal Article
SR Electronic
T1 Combined GLP-1, Oxyntomodulin, and Peptide YY Improves Body Weight and Glycemia in Obesity and Prediabetes/Type 2 Diabetes: A Randomized, Single-Blinded, Placebo-Controlled Study
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP 1446
OP 1453
DO 10.2337/dc19-0449
VO 42
IS 8
A1 Behary, Preeshila
A1 Tharakan, George
A1 Alexiadou, Kleopatra
A1 Johnson, Nicholas
A1 Wewer Albrechtsen, Nicolai J.
A1 Kenkre, Julia
A1 Cuenco, Joyceline
A1 Hope, David
A1 Anyiam, Oluwaseun
A1 Choudhury, Sirazum
A1 Alessimii, Haya
A1 Poddar, Ankur
A1 Minnion, James
A1 Doyle, Chedie
A1 Frost, Gary
A1 Le Roux, Carel
A1 Purkayastha, Sanjay
A1 Moorthy, Krishna
A1 Dhillo, Waljit
A1 Holst, Jens J.
A1 Ahmed, Ahmed R.
A1 Prevost, A. Toby
A1 Bloom, Stephen R.
A1 Tan, Tricia M.
YR 2019
UL http://care.diabetesjournals.org/content/42/8/1446.abstract
AB OBJECTIVE Roux-en-Y gastric bypass (RYGB) augments postprandial secretion of glucagon-like peptide 1 (GLP-1), oxyntomodulin (OXM), and peptide YY (PYY). Subcutaneous infusion of these hormones (“GOP”), mimicking postprandial levels, reduces energy intake. Our objective was to study the effects of GOP on glycemia and body weight when given for 4 weeks to patients with diabetes and obesity.RESEARCH DESIGN AND METHODS In this single-blinded mechanistic study, obese patients with prediabetes/diabetes were randomized to GOP (n = 15) or saline (n = 11) infusion for 4 weeks. We also studied 21 patients who had undergone RYGB and 22 patients who followed a very low-calorie diet (VLCD) as unblinded comparators. Outcomes measured were 1) body weight, 2) fructosamine levels, 3) glucose and insulin during a mixed meal test (MMT), 4) energy expenditure (EE), 5) energy intake (EI), and 6) mean glucose and measures of glucose variability during continuous glucose monitoring.RESULTS GOP infusion was well tolerated over the 4-week period. There was a greater weight loss (P = 0.025) with GOP (mean change −4.4 [95% CI −5.3, −3.5] kg) versus saline (−2.5 [−4.1, −0.9] kg). GOP led to a greater improvement (P = 0.0026) in fructosamine (−44.1 [−62.7, −25.5] µmol/L) versus saline (−11.7 [−18.9, −4.5] µmol/L). Despite a smaller weight loss compared with RYGB and VLCD, GOP led to superior glucose tolerance after a mixed-meal stimulus and reduced glycemic variability compared with RYGB and VLCD.CONCLUSIONS GOP infusion improves glycemia and reduces body weight. It achieves superior glucose tolerance and reduced glucose variability compared with RYGB and VLCD. GOP is a viable alternative for the treatment of diabetes with favorable effects on body weight.