Treatment with an oral proteinase inhibitor slows gastric emptying and acutely reduces glucose and insulin levels after a liquid meal in type II diabetic patients

OBJECTIVE - To determine whether an oral trypsin/chymotrypsin inhibitor, POT II will delay the rate of gastric emptying in recently diagnosed type II diabetic patients and improve their postprandial metabolic parameters. RESEARCH DESIGN AND METHODS - Two gastric emptying studies were performed on each of six type II diabetic patients. During one study, the patient ingested a glucose/protein solution, and during the other study, the patient ingested the same glucose/protein solution with the addition of 1.5 g of POT II, a putative stimulant of cholecystokinin (CCK) release. Each patient served as their own control subject. Each of the two oral solutions were administered to the patients in a counter-balanced order separated by at least 1 week. RESULTS - Serum insulin, plasma glucose, plasma gastric inhibitory polypeptide (GTP) values, and the rate of gastric emptying were all significantly (P < 0.05) decreased over the 2-h testing period when POT II was added to the oral glucose/protein meal. The area under the curve above baseline for glucose with POT II was 75% of the glucose value without POT II. The area under the curve above baseline for insulin with POT II was 68% of the value without POT II. Plasma CCK was significantly increased by POT II 15 min postprandially. CONCLUSIONS - A trypsin/chymotrypsin inhibitor, POT II, can delay the rate of gastric emptying, and decrease postprandial plasma glucose levels, GIP levels, and serum insulin levels in type II diabetic patients diagnosed recently. Delay of gastric emptying in diabetic patients may provide a unique or adjunctive approach to the treatment of type II diabetes.