Efficacy analysis was performed on the intention-to-treat population with missing values imputed by last RESULTS: More patients achieved A1C targets (<7% and ≤6%) with liraglutide versus exenatide or sitagliptin; the difference was greatest for A1C ≤6% (LEAD-6: 65% versus 35%; odds ratio [OR]=37, 95% confidence interval [CI]: 11-83; P = 1 or LIRA-DPP-4: 53% versus 19%; OR = 48, 95% CI 20 to 107; P = 002). Significantly more patients achieved a composite endpoint of A1C <7% with no weight gain or hypoglycemia with liraglutide compared with exenatide (78% versus 42%; OR = 49, 95% CI: 17 to 144; P = 023) or sitagliptin (61% versus 21%; OR = 55, 95% CI: 26 to 139; P<001). All treatments were well tolerated, there was no major hypoglycemia and few patients (8 to 10%) experienced minor hypoglycemia.CONCLUSION: When added to metformin in patients with an A1C <8%, more patients using liraglutide 1 mg reached A1C targets than with exenatide or sitagliptin. glipizide drug class had particularly low efficacy in this analysis. These data support the use of liraglutide 1 mg as a safe and effective alternative to sitagliptin or exenatide following metformin failure in patients with an A1C <8%. Jejunal feeding is followed by a greater rise in plasma cholecystokinin, peptide YY, glucagon-like peptide 1, and glucagon-like peptide 2 concentrations compared with gastric feeding in vivo in humans: a randomized trial.Department of Biomedical Sciences, The Panum Institute, University of Maastricht University, Maastricht, Netherlands.BACKGROUND: Jejunal feeding is preferred instead of gastric feeding in patients who are intolerant to gastric feeding or at risk of aspiration. However, the impact of gastric feeding compared with that of jejunal feeding on postprandial circulating plasma glucose and amino acid concentrations and the associated endocrine response in vivo in humans remains largely unexplored.OBJECTIVE: We compared the impact of administering enteral nutrition as either gastric feeding or jejunal feeding on endocrine responses in vivo in humans.DESIGN: In a randomized, crossover study design, 12 healthy young men (mean ± SD age: 21 ± 2 y) received continuous enteral nutrition that contained noncoagulating proteins for 12 h via a nasogastric tube or a nasojejunal tube placed 30-40 cm distal to the ligament of Treitz. Blood samples were collected during the 12-h postprandial period to assess the rise in plasma glucose, amino acid, and gastrointestinal hormone concentrations. RESULTS: Pancreatic hormones and other blood sugar regulating drugs were observed in the postprandial rise in circulating plasma amino acid and glucose concentrations between regimens. Jejunal feeding resulted in higher peak plasma insulin concentrations than did gastric feeding (392 ± 53 compared with 326 ± 54 pmol/L, respectively; P < 05). The postprandial rise in plasma cholecystokinin, peptide YY (PYY), glucagon-like peptide 1 (GLP-1), and glucagon-like peptide 2 (GLP-2) concentrations was greater after jejunal feeding than after gastric feeding, with higher peak concentrations and a greater postprandial incremental AUC for GLP-1 and cholecystokinin (all P < 05). Plasma ghrelin concentrations did not differ CONCLUSIONS: Enteral nutrition with gastric or jejunal feeding in healthy young men results in similar postprandial plasma amino acid and glucose concentrations. However, the endocrine response differs substantially, with higher peak plasma cholecystokinin, PYY, GLP-1, and GLP-2 concentrations being attained after jejunal feeding. This effect may result in an improved anabolic response, greater insulin sensitivity, and an improved intestinotropic effect. Nevertheless, it may also lead to delayed gastric emptying. This trial was registered at trialregister.nl as NTR2801.Regimen comprising GLP-1 receptor agonist and basal insulin can decrease the effect of food on glycemic variability compared to a pre-mixed insulin regimen.Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan.BACKGROUND: Increasing evidence suggests that glucagon-like peptide 1 (GLP-1) receptor agonists (RA) can stabilize glycemic variability (GV) and interfere with eating behavior. This study compared the impact of insulin, GLP-1 RA, and dietary components on GV using professional continuous glucose monitoring (CGM).METHODS: Patients with type 2 diabetes underwent CGM before and after switching from a twice-daily pre-mixed insulin treatment regimen to a GLP-1 RA (liraglutide) plus basal insulin regimen. The dietary components were recorded and analyzed by a certified dietitian. The interactions between the medical regimen, GV indices, and nutrient components were analyzed.RESULTS: Sixteen patients with type 2 diabetes were enrolled in this study. No significant differences in the diet components and total calorie intake between the two regimens were found.
glipizide drug class|Pancreatic hormones and other blood sugar regulating drugs
