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e
lu3,
lu5,en6,
1 Division of Gastroenterology, Department of Internal
Medicine, University of Marmara Medical School, Istanbul 81326;
2 Department of Computer Engineering, Boaziçi
University, Istanbul 80815; Departments of 3 Nuclear Medicine,
4 Biochemistry, 5 Biostatistics, and 6
Physiology, University of Marmara Medical School, Istanbul 81326, Turkey; and 7 Department of Clinical Biochemistry,
Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen; and
8 Department of Medical Physiology, The Panum Institute,
University of Copenhagen, DK-2200 Copenhagen, Denmark
We investigated the
effect of acarbose, an 
-glucosidase and pancreatic -amylase
inhibitor, on gastric emptying of solid meals of varying nutrient
composition and plasma responses of gut hormones. Gastric emptying was
determined with scintigraphy in healthy subjects, and all studies were
performed with and without 100 mg of acarbose, in random order, at
least 1 wk apart. Acarbose did not alter the emptying of a
carbohydrate-free meal, but it delayed emptying of a mixed meal and a
carbohydrate-free meal given 2 h after sucrose ingestion. In meal
groups with carbohydrates, acarbose attenuated responses of plasma
insulin and glucose-dependent insulinotropic polypeptide (GIP) while
augmenting responses of CCK, glucagon-like peptide-1 (GLP-1), and
peptide YY (PYY). With mixed meal + acarbose, area under the curve
(AUC) of gastric emptying was positively correlated with integrated
plasma response of GLP-1 (r = 0.68, P < 0.02). With the carbohydrate-free meal after sucrose and acarbose
ingestion, AUC of gastric emptying was negatively correlated with
integrated plasma response of GIP, implying that prior alteration of
carbohydrate absorption modifies gastric emptying of a meal. The
results demonstrate that acarbose delays gastric emptying of solid
meals and augments release of CCK, GLP-1, and PYY mainly by
retarding/inhibiting carbohydrate absorption. Augmented GLP-1 release
by acarbose appears to play a major role in the inhibition of gastric
emptying of a mixed meal, whereas CCK and PYY may have contributory roles.
insulin; diabetes; ileal brake; peptide YY; glucose-dependent insulinotropic polypeptide; blood glucose
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