Incretin-Like Glycemic and Metabolic Effects of Luminal Starch Blockers

Luminal glucosidase inhibitors and GLP-1 agents (incretins) bring about similar, dose-related improvements in post-prandial glycemic and insulinogenic responses to ingested carbohydrates in man and animals.The metabolic improvements are likely due to the combined physiological effects of both decreasing the rate of gastric emptying and subsequent delays in carbohydrate digestion and luminal glucose uptake, combined with modest decreases in caloric intake with both therapeutic regimens.The combined impact of the above ultimately results in decreases in insulinogenic responses and improved insulin sensitivity in peripheral tissues.Both therapeutic approaches result in an approximate 15% decrease in daily caloric intake and decreases in plasma insulin and improved plasma lipid profiles, in a manner that is somewhat analogous to the consumption of a higher fiber, low glycemic index, and complex carbohydrate diet.While the duration of the GLP-1 approach may prove to be therapeutically effective for only a limited duration often of one year or less, dietary approaches to control caloric intake including glucosidase inhibitors typically may be continued indefinitely and with minimal risk of long-term adverse or rebound effects.Thus, the combination of GLP-1 (incretin) agonists, -glucosidase inhibitors, and dietary and lifestyle interventions as monotherapy or combined therapy may prove to be useful adjuncts in addressing the global burgeoning problems linked to obesity, T2DM and insulin-resistant states in man and animals.