Herz- und Diabeteszentrum NRW, Diabeteszentrum, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Herz- und Diabeteszentrum NRW, Institut für Laboratoriums- und Transfusionsmedizin, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Horm Metab Res. 2019 Apr;51(4):267-273. doi: 10.1055/a-0818-6374. Epub 2019 Jan 28.
The effect of the treatment with glucagon-like peptide (GLP)-1 receptor agonists on gastric emptying in patients with diabetes with and without gastroparesis is analysed. Patients with type 2 diabetes mellitus subjected to GLP-1 receptor agonist therapy with exenatide were examined before and shortly after initiation of treatment. Gastric half-emptying time was determined by C-octanoic breath test; routine laboratory parameter as well as active GLP-1, ghrelin, leptin, insulin, proinsulin and C-peptide levels were determined in fasting state as well as postprandial secretion within 1 h after a standardised meal. Thirty patients' data sets were available for evaluation, of those 20 patients had no gastroparesis and 10 patients showed pathological results following the breath test. Gastric half-emptying time was prolonged in nearly all patients who presented without gastroparesis at initiation of treatment with GLP-1 receptor agonists, only 2 patients with pre-existing mild gastroparesis had worsening of gastric emptying. No effect was detected on leptin and ghrelin levels. Postprandial GLP-1 concentrations measured as AUC after meal decreased significantly. Fasting insulin and C-peptide levels increased significantly without effect on postprandial levels. Proinsulin levels - fasting as well as AUC - decreased non-significantly. Patients reported comparable perception of therapeutic effects. Treatment with GLP-1 receptor agonists may be applied in patients with pre-existing gastroparesis; no effect in terms of worsening of symptoms compared to those without gastroparesis was detected. Patients reported outcome was independent from underlying gastroparesis. Negative effects on gastric emptying were only detected in patients without or with mild gastroparesis.
分析了胰高血糖素样肽（GLP）-1 受体激动剂治疗对伴有或不伴有胃轻瘫的糖尿病患者胃排空的影响。检查了接受 exenatide 治疗的 2 型糖尿病患者在开始治疗前和治疗后不久的情况。通过 C-辛酸呼气试验确定胃排空半时；空腹和餐后 1 小时内餐后分泌测定常规实验室参数以及活性 GLP-1、ghrelin、瘦素、胰岛素、胰岛素原和 C 肽水平。有 30 个患者的数据可用于评估，其中 20 个患者没有胃轻瘫，10 个患者在呼吸试验后出现病理结果。在开始使用 GLP-1 受体激动剂治疗时，几乎所有没有胃轻瘫的患者的胃排空时间都延长了，只有 2 名患有预先存在的轻度胃轻瘫的患者胃排空恶化。对瘦素和 ghrelin 水平没有影响。餐后 GLP-1 浓度作为餐后 AUC 显著降低。空腹胰岛素和 C 肽水平显著增加，但餐后水平没有影响。胰岛素原水平 - 空腹和 AUC - 非显著降低。患者报告的治疗效果相当。在有预先存在的胃轻瘫的患者中可以应用 GLP-1 受体激动剂治疗；与没有胃轻瘫的患者相比，没有发现症状恶化的影响。患者报告的结果与潜在的胃轻瘫无关。仅在无或轻度胃轻瘫的患者中检测到对胃排空的负性影响。
