The effect of dipeptidyl peptidase-4 inhibition on gastric volume, satiation and enteroendocrine secretion in type 2 diabetes: A double-blind, placebo-controlled crossover study

Adrian Vella, Gerlies Bock, Paula D. Giesler, Duane B. Burton, Denise B. Serra, Monica Ligueros Saylan, Carolyn F. Deacon, James E. Foley, Robert A. Rizza, Michael Camilleri

Research output: Contribution to journalArticle

41 Scopus citations


Objectives: The incretin hormone glucagon-like peptide-1 (GLP-1) retards gastric emptying and decreases caloric intake. It is unclear whether increased GLP-1 concentrations achieved by inhibition of the inactivating enzyme dipeptidyl peptidase-4 (DPP-4) alter gastric volumes and satiation in people with type 2 diabetes. Methods: In a double-blind, placebo-controlled crossover design, 14 subjects with type 2 diabetes received vildagliptin (50 mg bid) or placebo for 10 days in random order separated by a 2-week washout. On day 7, fasting and postmeal gastric volumes were measured by a 99mTc single-photon emission computed tomography (SPECT) method. On day 8, a liquid Ensure® meal was consumed at 30 ml/min, and maximum tolerated volume (MTV) and symptoms 30 min later were measured using a visual analogue scale (VAS) to assess effects on satiation. On day 10, subjects ingested water until maximum satiation was achieved. The volume ingested was recorded and symptoms similarly measured using a VAS. Results: Vildagliptin raised plasma GLP-1 concentrations. However, fasting (248 ± 21 vs. 247 ± 19 ml, P = 0.98) and fed (746 ± 28 vs. 772 ± 26 ml, P = 0.54) gastric volumes did not differ when subjects received vildagliptin or placebo. Treatment with vildagliptin did not alter the MTV of Ensure® (1657 ± 308 vs. 1389 ± 197 ml, P = 0.15) or water compared to placebo (1371 ± 141 vs. 1172 ± 156 ml, P = 0.23). Vildagliptin was associated with decreased peptide YY (PYY) concentrations 60 min after initiation of the meal (166 ± 27 vs. 229 ± 34 pmol/l, P = 0.01). Conclusions: Vildagliptin does not alter satiation or gastric volume in people with type 2 diabetes despite elevated GLP-1 concentrations. Compensatory changes in enteroendocrine secretion could account for the lack of gastrointestinal symptoms.

Original languageEnglish (US)
Pages (from-to)737-744
Number of pages8
JournalClinical Endocrinology
Issue number5
StatePublished - Nov 1 2008


ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this