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Diabetic and nondiabetic patients with nonalcoholic fatty liver disease have an impaired incretin effect and fasting hyperglucagonaemia
Author(s) -
Junker A. E.,
Gluud L.,
Holst J. J.,
Knop F. K.,
Vilsbøll T.
Publication year - 2016
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12462
Subject(s) - medicine , nonalcoholic fatty liver disease , incretin , endocrinology , type 2 diabetes , diabetes mellitus , impaired glucose tolerance , interquartile range , fatty liver , body mass index , gastroenterology , disease
Objective We evaluated whether patients with histologically verified nonalcoholic fatty liver disease ( NAFLD ) have an impaired incretin effect and hyperglucagonaemia. Methods Four groups matched for age, sex and body mass index were studied: (i) 10 patients with normal glucose tolerance and NAFLD ; (ii) 10 patients with type 2 diabetes and NAFLD ; (iii) eight patients with type 2 diabetes and no liver disease; and (iv) 10 controls. All participants underwent a 50‐g oral glucose tolerance test ( OGTT ) and an isoglycaemic intravenous glucose infusion ( IIGI ). We determined the incretin effect by relating the beta cell secretory responses during the OGTT and IIGI . Data are presented as medians (interquartile range), and the groups were compared by using the Kruskal–Wallis test. Results Controls exhibited a higher incretin effect [55% (43–73%)] compared with the remaining three groups ( P < 0.001): 39% (44–71%) in the nondiabetic NAFLD patients, 20% (−5−50%) in NAFLD patients with type 2 diabetes, and 2% (−8−6%) in patients with type 2 diabetes and no liver disease. We found fasting hyperglucagonaemia in NAFLD patients with [7.5 pmol L −1 (6.8–15 pmol L −1 )] and without diabetes [7.5 pmol L −1 (5.0–8.0 pmol L −1 )]. Fasting glucagon levels were lower but similar in patients with type 2 diabetes and no liver disease [4.5 pmol L −1 (3.0–6.0 pmol L −1 )] and controls [3.4 pmol L −1 (1.8–6.0 pmol L −1 )]. All groups had similar glucagon‐like peptide‐1 and glucose‐dependent insulinotropic polypeptide responses. Conclusions Patients with NAFLD have a reduced incretin effect and fasting hyperglucagonaemia, with the latter occurring independently of glucose (in)tolerance.