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Miglitol Reduces Blood Glucose and Modifies Appetite in Obese P

Miglitol decreased hunger and increased feelings of satiety after a meal in obese, diabetic patients Which resulted in a lower caloric intake for those patients, according to researchers in the U.S. and Australia.

"Previous studies reported that administration of first generation alpha-glucosidase inhibitors (AGIs), such as voglibose or acarbose, produced exaggerated and sustained postprandial responses of glucagon-like peptide-1 (GLP-1), an incretin hormone from the enteroinsular axis, in healthy humans," said Adrian Lee and colleagues at St. Louis University Medical Center in the U. S. and the University of Adelaide in Australia.

They added, "Any agent that substantially elevates GLP-1 levels may theoretically reduce hunger, increase satiation and limit food intake. This study was performed to analyze the effect of miglitol, a more potent second generation AGI with fewer gastrointestinal side-effects, on the regulation of meal-related GLP-1 secretion and on the change of insulin-glucose dynamics as well as the release of gastric inhibitory polypeptide (GIP), another incretin hormone, after stimulation by an ordinary meal in obese type-2-diabetic subjects."

The investigators randomly assigned 8 obese women with type 2 diabetes to receive either miglitol (100 mg) or placebo 3 times daily for 2 days. The amount of food consumed was determined by calorie intake at lunch. On the third day of the study, the researchers measured levels of GLP-1, GIP, insulin, and glucose within 3 hours after the subjects consumed a 720-kcal breakfast (The effects of miglitol on glucagon-like peptide-1 secretion and appetite sensations in obese type 2 diabetics. Diabetes, Obesity, and Metabolism, , 2002;4(5):329-335).

Postprandial GIP release was suppressed and GLP-1 production was enhanced in the patients who received miglitol. GLP-1 levels were two times greater in miglitol patients compared with the control patients and reached a maximum concentration 120 minutes after a meal.

Six of the eight subjects whose GLP-1 levels rose more than 30% from placebo-treated levels consumed 12% fewer calories (p<0.05) compared with placebo. Patients who received miglitol also reported lower levels of hunger and greater feelings of satiety than did patients who received placebo.

"Miglitol induced an enhanced and prolonged GLP-1 release at high physiological concentrations after ingesting an ordinary meal in glycemic-controlled diabetics," concluded Lee and associates. "The excessive postprandial GLP-1 elevation after miglitol therapy modified feeding behavior and food intake, and thereby has potential value in regulating appetite and stabilizing body weight in obese type-2-diabetic patients."

Key points reported in this study include:

* The alpha-glucosidase inhibitor, miglitol, decreased postprandial gastric inhibitory polypeptide (GIP) and increased postprandial glucagon-like peptide-1 (GLP-1) release in obese patients with type 2 diabetes compared with subjects who received a placebo

* Miglitol decreased appetite and increased feelings of satiety in obese, type 2 diabetic subjects compared with subjects who received placebo

* Obese, type 2 diabetic subjects who received miglitol consumed significantly fewer calories than did subjects who received placebo This article was prepared by Diabetes Week editors from staff and other reports.