Pronounced reduction of postprandial glucagon by lixisenatide:a meta-analysis of randomized clinical trials

Glucagon-like peptide-1 (GLP-1) receptor agonists improve islet function and delay gastric emptying in patients with type 2 diabetes mellitus (T2DM). This meta-analysis aimed to investigate the effects of the once-daily prandial GLP-1 receptor agonist lixisenatide on postprandial plasma glucose (PPG), glucagon and insulin levels. Methods: Six randomized, placebo-controlled studies of lixisenatide 20μg once daily were included in this analysis: lixisenatide as monotherapy (GetGoal-Mono), as add-on to oral antidiabetic drugs (OADs; GetGoal-M, GetGoal-S) or in combination with basal insulin (GetGoal-L, GetGoal-Duo-1 and GetGoal-L-Asia). Change in 2-h PPG and glucose excursion were evaluated across six studies. Change in 2-h glucagon and postprandial insulin were evaluated across two studies. A meta-analysis was performed on least square (LS) mean estimates obtained from analysis of covariance (ANCOVA)-based linear regression. Results: Lixisenatide significantly reduced 2-h PPG from baseline (LS mean difference vs. placebo: -4.9mmol/l, p<0.001) and glucose excursion (LS mean difference vs. placebo: -4.5mmol/l, p<0.001). As measured in two studies, lixisenatide also reduced postprandial glucagon (LS mean difference vs. placebo: -19.0ng/l, p<0.001) and insulin (LS mean difference vs. placebo: -64.8 pmol/l, p<0.001). There was a stronger correlation between 2-h postprandial glucagon and 2-h PPG with lixisenatide than with placebo. Conclusions: Lixisenatide significantly reduced 2-h PPG and glucose excursion together with a marked reduction in postprandial glucagon and insulin; thus, lixisenatide appears to have biological effects on blood glucose that are independent of increased insulin secretion. These effects may be, in part, attributed to reduced glucagon secretion. © 2014 John Wiley and Sons Ltd.

FREADMAN, AnneThe Livres-Souvenirs of Colette Genre and the Telling of Time Oxford: Legenda, August 2012200 pp., £40.00, ISBN: 978-1-906540-93-7

Full text: The title of the book gives us a major clue on the innovative approach developed by Anne Freadman in her analysis of a particular Colette corpus, the one devoted to auto-biographical writing: Les Vrilles de la vigne, Mes apprentissages, La Maison de Claudine, Sido ,L’E ́toile Vesper and Le Fanal bleu. Freadman follows the powerful lure of Rimbaldianvieilles vieilleries and its echoes with Colette’s fondness for collecting objects, people and memories. To this must be added a technical aspect, that of the study of the genre of Colette’s writing. Freadman argues that, by largely avoiding the autobiographical form, the writer achieves a new way of ‘telling time’, collecting anecdotes and detail taken from the quotidian and setting them within an all-encompassing preoccupation with time. This provides the second part of the title.The sonata form directs the sequence of the book, orchestrated into five parts,from ‘exposition’ to ‘first subject’ to‘bridge’ to ‘second subject’ to ‘recapitulation’. This has the advantage of enabling Freadman to move and progress between distinct themes—autobiography first,then alternative forms—with grace,whilst preserving within her own writing what she sees as the essence of Colette’s relationship to time in her ‘Livres-Souvenirs’, the telling of time. This‘telling of time’ is itself therefore cleverly subjected to the time constraints and freedoms of musical composition. Freadman’s ‘Exposition’ takes us through a discussion of the autobiographical genre, analysing the texts against anumber of theorists, from Lejeune to Benjamin and Ricoeur, before launching into ‘Colette and Autobiography’. It argues pertinently that Colette did not write a ‘sustained’ autobiography, even inthe most autobiographical of her writings, Mes apprentissages. Measured against Goodwin’s three sources for autobiography, confession, apologia and memoirs, Colette’s autobiographical writings appear to be at odds with all of them. Freadman then goes on in Part II of her argument, to persuasively uncover a project that rejects self-scrutiny and with no autobiographical strategy. In ‘Collecting Time’, despite claims of continuity, narrative logic and causality areabandoned in favour of a collection offragments, family stories that are built up generation after generation into familylegends. A close and fruitful analysis of Sidoleads us to a study of ‘The Art of Ending’, concentrating on L’E ́toile Vesperandle Fanal Bleu. The closing chapter gives a fascinating reading of La Naissance du jouras an exemplar of the way in which the two subjects developed in Freadman’s volume are cast together:Colette’s own working through the autobiographical genre, and her refusal to write memoirs, in favour of collecting memories, and the strategies she uses for her purpose. In ‘Recapitulation’, her concluding chapter, Freadman adroitlyen capsulates her analysis in a fetching title: ‘Fables of Time’. Indeed, the wholepremise of her book is to move away from autobiographical genre, having acknowledged the links and debt the corpus owes to it, and into a study of the multiple and fruitful ways in which Colette tells time.The rich and varied readings of thematerial, competently informed by theoretical input, together with acute sensitivity to the corpus, mark out this study as incontournable for Colette scholars.

Consistent reduction of postprandial glucagon and insulin by lixisenatide in the GetGoal clinical trial programme

Background and aims: Glucagon-like peptide-1 (GLP-1) receptor agonists improve islet function and delay gastric emptying in subjects with type 2 diabetes mellitus. We evaluated 2-hour glucose, glucagon and insulin changes following a standardized mixed-meal tolerance test before and after 24 weeks of treatment with the once-daily prandial GLP-1 receptor agonist lixisenatide (approved for a therapeutic dose of 20 μg once daily) in six randomized, placebo-controlled studies within the lixisenatide Phase III GetGoal programme. In the studies, the mixed-meal test was conducted before and after: (1) lixisenatide treatment in patients insufficiently controlled despite diet and exercise (GetGoal-Mono), (2) lixisenatide treatment in combination with oral antidiabetic drugs (OADs) (GetGoal-M and GetGoal-S), or (3) lixisenatide treatment in combination with basal insulin ± OAD (GetGoal-Duo 1, GetGoal-L and GetGoal-L-Asia).Materials and methods: A meta-analysis was performed (lixisenatide n=1124 vs placebo n=707) combining ANCOVA least squares (LS) mean values using an inverse variance weighted analysis. Results: Lixisenatide significantly reduced 2-hour postprandial glucose from baseline (LS mean difference vs placebo: -4.9 mmol/L, p<0.0001, Figure) and glucose excursions (LS mean difference vs placebo: -4.5 mmol/L, p<0.0001). As measured in two studies, lixisenatide also reduced postprandial glucagon (LS mean difference vs placebo: -19.0 ng/L, p<0.0001) and insulin (LS mean difference vs placebo: -64.8 pmol/L, p<0.0001), although the glucagon/insulin ratio was increased (LS mean difference vs placebo: 0.15, p=0.02) compared with placebo. Conclusion: The results show that lixisenatide potently reduces the glucose excursion after meal ingestion in subjects with type 2 diabetes, in association with marked reductions in glucagon and insulin levels. It is suggested that diminished glucagon secretion and slower gastric emptying contribute to reduced hepatic glucose production and delayed glucose absorption, enabling postprandial glycaemia to be controlled with less demand on beta-cell insulin secretion. Clinical Trial Registration Number: NCT00688701; NCT00712673; NCT00713830; NCT00975286; NCT00715624; NCT00866658 Supported by: Sanofi