Glucose-lowering effects and mechanisms of the bile acid-sequestering resin sevelamer
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Glucose-lowering effects and mechanisms of the bile acid-sequestering resin sevelamer. / Brønden, Andreas; Mikkelsen, Kristian; Sonne, David P.; Hansen, Morten; Våben, Christoffer; Gabe, Maria N.; Rosenkilde, Mette; Tremaroli, Valentina; Wu, Hao; Bäckhed, Fredrik; Rehfeld, Jens F.; Holst, Jens J.; Vilsbøll, Tina; Knop, Filip K.
In: Diabetes, Obesity and Metabolism, Vol. 20, No. 7, 07.2018, p. 1623-1631.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Glucose-lowering effects and mechanisms of the bile acid-sequestering resin sevelamer
AU - Brønden, Andreas
AU - Mikkelsen, Kristian
AU - Sonne, David P.
AU - Hansen, Morten
AU - Våben, Christoffer
AU - Gabe, Maria N.
AU - Rosenkilde, Mette
AU - Tremaroli, Valentina
AU - Wu, Hao
AU - Bäckhed, Fredrik
AU - Rehfeld, Jens F.
AU - Holst, Jens J.
AU - Vilsbøll, Tina
AU - Knop, Filip K.
PY - 2018/7
Y1 - 2018/7
N2 - Aims: Sevelamer, a non-absorbable amine-based resin used for treatment of hyperphosphataemia, has been demonstrated to have a marked bile acid-binding potential alongside beneficial effects on lipid and glucose metabolism. The aim of this study was to investigate the glucose-lowering effect and mechanism(s) of sevelamer in patients with type 2 diabetes. Materials and Methods: In this double-blinded randomized controlled trial, we randomized 30 patients with type 2 diabetes to sevelamer (n = 20) or placebo (n = 10). Participants were subjected to standardized 4-hour liquid meal tests at baseline and after 7 days of treatment. The main outcome measure was plasma glucagon-like peptide-1 excursions as measured by area under the curve. In addition, blood was sampled for measurements of glucose, lipids, glucose-dependent insulinotropic polypeptide, C-peptide, glucagon, fibroblast growth factor-19, cholecystokinin and bile acids. Assessments of gastric emptying, resting energy expenditure and gut microbiota composition were performed. Results: Sevelamer elicited a significant placebo-corrected reduction in plasma glucose with concomitant reduced fibroblast growth factor-19 concentrations, increased de novo synthesis of bile acids, a shift towards a more hydrophilic bile acid pool and increased lipogenesis. No glucagon-like peptide-1-mediated effects on insulin, glucagon or gastric emptying were evident, which points to a limited contribution of this incretin hormone to the glucose-lowering effect of sevelamer. Furthermore, no sevelamer-mediated effects on gut microbiota composition or resting energy expenditure were observed. Conclusions: Sevelamer reduced plasma glucose concentrations in patients with type 2 diabetes by mechanisms that seemed to involve decreased intestinal and hepatic bile acid-mediated farnesoid X receptor activation.
AB - Aims: Sevelamer, a non-absorbable amine-based resin used for treatment of hyperphosphataemia, has been demonstrated to have a marked bile acid-binding potential alongside beneficial effects on lipid and glucose metabolism. The aim of this study was to investigate the glucose-lowering effect and mechanism(s) of sevelamer in patients with type 2 diabetes. Materials and Methods: In this double-blinded randomized controlled trial, we randomized 30 patients with type 2 diabetes to sevelamer (n = 20) or placebo (n = 10). Participants were subjected to standardized 4-hour liquid meal tests at baseline and after 7 days of treatment. The main outcome measure was plasma glucagon-like peptide-1 excursions as measured by area under the curve. In addition, blood was sampled for measurements of glucose, lipids, glucose-dependent insulinotropic polypeptide, C-peptide, glucagon, fibroblast growth factor-19, cholecystokinin and bile acids. Assessments of gastric emptying, resting energy expenditure and gut microbiota composition were performed. Results: Sevelamer elicited a significant placebo-corrected reduction in plasma glucose with concomitant reduced fibroblast growth factor-19 concentrations, increased de novo synthesis of bile acids, a shift towards a more hydrophilic bile acid pool and increased lipogenesis. No glucagon-like peptide-1-mediated effects on insulin, glucagon or gastric emptying were evident, which points to a limited contribution of this incretin hormone to the glucose-lowering effect of sevelamer. Furthermore, no sevelamer-mediated effects on gut microbiota composition or resting energy expenditure were observed. Conclusions: Sevelamer reduced plasma glucose concentrations in patients with type 2 diabetes by mechanisms that seemed to involve decreased intestinal and hepatic bile acid-mediated farnesoid X receptor activation.
KW - antidiabetic drug
KW - drug mechanism
KW - GLP-1
KW - glucose metabolism
KW - type 2 diabetes
U2 - 10.1111/dom.13272
DO - 10.1111/dom.13272
M3 - Journal article
C2 - 29493868
AN - SCOPUS:85044428655
VL - 20
SP - 1623
EP - 1631
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
SN - 1462-8902
IS - 7
ER -
ID: 200383994