Details

Autor(en) / Beteiligte

• Dalsgaard, Niels B.
• Gasbjerg, Lærke S.
• Helsted, Mads M.
• Hansen, Laura S.
• Hansen, Nina L.
• Skov-Jeppesen, Kirsa
• Hartmann, Bolette
• Holst, Jens J.
• Vilsbøll, Tina
• Knop, Filip K.

Titel

Acarbose diminishes postprandial suppression of bone resorption in patients with type 2 diabetes

Ist Teil von

• Bone (New York, N.Y.), 2023-05, Vol.170, p.116687-116687, Article 116687

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2023

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• The alpha-glucosidase inhibitor acarbose is an antidiabetic drug delaying assimilation of carbohydrates and, thus, increasing the amount of carbohydrates in the distal parts of the intestines, which in turn increases circulating levels of the gut-derived incretin hormone glucagon-like peptide 1 (GLP-1). As GLP-1 may suppress bone resorption, acarbose has been proposed to potentiate meal-induced suppression of bone resorption. We investigated the effect of acarbose treatment on postprandial bone resorption in patients with type 2 diabetes and used the GLP-1 receptor antagonist exendin(9-39)NH2 to disclose contributory effect of acarbose-induced GLP-1 secretion. In a randomised, placebo-controlled, double-blind, crossover study, 15 participants with metformin-treated type 2 diabetes (2 women/13 men, age 71 (57–85 years), BMI 29.7 (23.6–34.6 kg/m2), HbA1c 48 (40–74 mmol/mol)/6.5 (5.8–11.6 %) (median and range)) were subjected to two 14-day treatment periods with acarbose and placebo, respectively, separated by a six-week wash-out period. At the end of each period, circulating bone formation and resorption markers were assessed during two randomised 4-h liquid mixed meal tests (MMT) with infusions of exendin(9-39)NH2 and saline, respectively. Glucagon-like peptide 2 (GLP-2) was also assessed. Compared to placebo, acarbose impaired the MMT-induced suppression of CTX as assessed by baseline-subtracted area under curve (P = 0.0037) and nadir of CTX (P = 0.0128). During acarbose treatment, exendin(9-39)NH2 infusion lowered nadir of CTX compared to saline (P = 0.0344). Neither parathyroid hormone or the bone formation marker procollagen 1 intact N-terminal propeptide were affected by acarbose or GLP-1 receptor antagonism. Acarbose treatment induced a greater postprandial GLP-2 response than placebo treatment (P = 0.0479) and exendin(9-39)NH2 infusion exacerbated this (P = 0.0002). In patients with type 2 diabetes, treatment with acarbose reduced postprandial suppression of bone resorption. Acarbose-induced GLP-1 secretion may contribute to this phenomenon as the impairment was partially reversed by GLP-1 receptor antagonism. Also, acarbose-induced reductions in other factors reducing bone resorption, e.g. glucose-dependent insulinotropic polypeptide, may contribute. •Alpha-glucosidase inhibition increases postprandial glucagon-like peptide 1 (GLP-1) secretion.•This has been suggested to potentiate postprandial suppression of bone resorption during alpha-glucosidase inhibition.•We used a GLP-1 receptor antagonist during alpha-glucosidase inhibitor treatment to elucidate this.•The alpha-glucosidase inhibitor acarbose reduced postprandial suppression of bone resorption.•GLP-1 receptor antagonism reversed acarbose's effect on postprandial bone resorption.