Gastric emptying, incretin hormone secretion, and postprandial glycemia in cystic fibrosis--effects of pancreatic enzyme supplementation

J Clin Endocrinol Metab. 2011 May;96(5):E851-5. doi: 10.1210/jc.2010-2460. Epub 2011 Mar 9.


Context: Postprandial hyperglycemia is an important clinical problem in cystic fibrosis (CF), but the contribution of fat malabsorption, rapid gastric emptying, and the incretin axis has not been widely considered.

Objective: The aim of this study was to evaluate these aspects of gut function in nondiabetic CF patients.

Design and setting: We conducted a randomized, double-blind, placebo-controlled crossover study at a clinical research laboratory.

Patients: Five nondiabetic CF patients (three males; age, 25.8 ± 1.0 yr; body mass index, 20.2 ± 1.1 kg/m(2)) with exocrine pancreatic insufficiency and six healthy subjects of similar age and body mass index participated in the study.

Interventions: CF patients consumed a radiolabeled mashed potato meal on 2 separate days, together with four capsules of Creon Forte (100,000 IU lipase) or placebo. Healthy subjects consumed the meal once, without pancreatic enzymes.

Main outcome measures: Gastric emptying was measured using scintigraphy, and blood was sampled frequently for blood glucose and plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon concentrations.

Results: CF patients had more rapid gastric emptying (P < 0.001), impaired secretion of GLP-1 (P < 0.01) and GIP (P < 0.001), and greater postprandial glycemic excursions (P < 0.001) than healthy subjects. Pancreatic enzyme supplementation normalized gastric emptying and GLP-1 secretion and tended to increase glucagon (P = 0.08), but did not completely restore GIP secretion or normalize postprandial blood glucose. There was an excellent correlation between gastric emptying and blood glucose concentration at 60 min (R = 0.75; P = 0.01).

Conclusions: Pancreatic enzyme supplementation plays an important role in incretin secretion, gastric emptying, and postprandial hyperglycemia in CF.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / metabolism*
  • Cystic Fibrosis / blood
  • Cystic Fibrosis / physiopathology*
  • Dietary Carbohydrates / pharmacology
  • Dietary Fats / pharmacology
  • Double-Blind Method
  • Female
  • Gastric Emptying / physiology*
  • Gastric Inhibitory Polypeptide / blood
  • Glucagon / blood
  • Glucagon-Like Peptide 1 / blood
  • Humans
  • Hyperglycemia / metabolism*
  • Incretins / metabolism*
  • Insulin / blood
  • Lipase / therapeutic use*
  • Male
  • Pancreas / enzymology*
  • Young Adult


  • Blood Glucose
  • Dietary Carbohydrates
  • Dietary Fats
  • Incretins
  • Insulin
  • Gastric Inhibitory Polypeptide
  • Glucagon-Like Peptide 1
  • Glucagon
  • Lipase