Journal of Diabetes and Clinical Studies

Incretins and Cardiovascular Effects of Weight Loss and Remission of Prediabetes

Author(s): Frankie B. Stentz, Andrew Mikhael, Omer Kineish, John Christman, Chris Sands

Aim and Background: The incretins GLP-1 and GIP have important roles in insulin sensitivity and have been shown to be effective in pharmacological treatment of Type 2 Diabetes and improvement in Cardiovascular Risk Factors (CVRF). Ghrelin has been shown to be associated with satiety. Therefore, we studied the GLP-1, GIP, Ghrelin and BNP changes with weight loss and remission of prediabetes. 
Methods and Results: 24 obese women and men with prediabetes were recruited and randomized to either a High Protein (HP) (n=12) or High Carbohydrate (HC) (n=12) diet for 6 months with all food provided. OGTT and MTT were performed and GLP-1, GIP, Ghrelin, BNP, insulin and glucose were measured at baseline and 6 months on the respective diets. 
Author’s studies showed that subjects on the HP diet had 100% remission of prediabetes compared to only 33% on the HC diet with similar weight loss. 
HP diet subjects had a greater increase in (1) OGTT GLP-1 AUC (p=0.001) and MTT GLP-1 AUC (p=0.001), (2) OGTT GIP AUC (p=0.005) and MTT GIP AUC (p=0.005), and a greater decrease in OGTT ghrelin AUC (0.005) and MTT ghrelin AUC (p=0.001) and BNP (p=0.001) compared to the HC diet at 6 months. 
Conclusions: This study demonstrates that the HP diet increases GLP-1 and GIP which may be responsible in part for improved insulin sensitivity and β cell function compared to the HC diet. HP ghrelin results demonstrate the HP diet can induce satiety more effectively than the HC diet. BNP and other CVRF, metabolic parameters and oxidative stress are significantly improved compared to the HC diet.

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