Genetic Variation Augments Incretin Resistance and Influences Response to a Sulfonylurea and Metformin: The Study to Understand the Genetics of the Acute Response to Metformin and Glipizide in Humans (SUGAR-MGH).

Diabetes Care
Publication type
Journal Article

OBJECTIVE: The rs7903146 T allele in transcription factor 7 like 2 () is strongly associated with type 2 diabetes (T2D), but the mechanisms for increased risk remain unclear. We evaluated the physiologic and hormonal effects of genotype before and after interventions that influence glucose physiology.

RESEARCH DESIGN AND METHODS: We genotyped rs7903146 in 608 individuals without diabetes and recorded biochemical data before and after ) one dose of glipizide (5 mg) on visit 1 and ) a 75-g oral glucose tolerance test (OGTT) performed after administration of metformin 500 mg twice daily over 2 days. Incretin levels were measured in 150 of the 608 participants.

RESULTS: TT risk-allele homozygotes had 1.6 mg/dL higher baseline fasting glucose levels and 2.5 pg/mL lower glucagon levels per T allele than carriers of other genotypes at baseline. In a subset of participants, the T allele was associated with higher basal glucagon-like peptide 1 (GLP-1) levels at visit 1 (β = 1.52, = 0.02 and β = 0.96, = 0.002 for total and active GLP-1, respectively), and across all points of the OGTT after metformin administration. Regarding drug response, the T allele was associated with a shorter time (β = -7.00, = 0.03) and a steeper slope (β = 0.23, = 0.04) to trough glucose levels after glipizide administration, and lower visit 2 fasting glucose level adjusted for visit 1 fasting glucose level (β = -1.02, = 0.04) and a greater decline in glucose level between visits (β = -1.61, = 0.047) after metformin administration.

CONCLUSIONS: Our findings demonstrate that common variation at influences acute responses to both glipizide and metformin in people without diabetes and highlight altered incretin signaling as a potential mechanism by which variation increases T2D risk.

Year of Publication
Diabetes Care
Date Published
2018 03
PubMed ID
PubMed Central ID
Grant list
K24 DK110550 / DK / NIDDK NIH HHS / United States
R03 DK077675 / DK / NIDDK NIH HHS / United States
P30 DK036836 / DK / NIDDK NIH HHS / United States
M01 RR001066 / RR / NCRR NIH HHS / United States
T32 DK007161 / DK / NIDDK NIH HHS / United States
R01 DK088214 / DK / NIDDK NIH HHS / United States
UL1 TR000170 / TR / NCATS NIH HHS / United States
UL1 RR025758 / RR / NCRR NIH HHS / United States