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The Insulin Secretagogues Glibenclamide and Repaglinide Do Not Influence Growth Hormone Secretion in Humans but Stimulate Glucagon Secretion during Profound Insulin Deficiency

Department of Medicine M (Endocrinology and Diabetes) (T.Ø., K.B.D., O.S.), University Hospital of Aarhus, and Department of Clinical Pharmacology (O.S.), University of Aarhus, DK-8000 Aarhus, Denmark; Novo Nordisk A/S (M.G., R.D.C., M.K.T.), 2880 Bagsvaerd, Denmark; and Division of Endocrinology (J.D.V., R.A.R.), Mayo Clinic and Foundation, Rochester, Minnesota 55905

Address all correspondence and requests for reprints to: Torben Østergård, M.D., Department of Medicine M (Endocrinology and Diabetes), University Hospital of Aarhus, AKH Nørrebrogade 42–44, DK-8000 Aarhus C, Denmark. E-mail: oest{at}dadlnet.dk.

In vitro data have recently suggested that sulfonylureas (SUs) enhance GH secretion by modulating the effects of GHRH and somatostatin in pituitary cells. The present study was undertaken to explore in more detail a possible influence of a single dose of SU (glibenclamide) and a non-SU (repaglinide) insulin secretagogue on circulating GH dynamics. Ten C-peptide-negative type 1 diabetic individuals were examined on three occasions in random order. Either glibenclamide (10.5 mg), repaglinide (8 mg), or placebo was administered after overnight normalization of plasma glucose by iv insulin infusion. Subsequently, GH concentrations were measured regularly after stimulation with GHRH (bolus 0.1 µg/kg) alone and during concomitant infusion with somatostatin (7 ng·kg^–1·min^–1). Insulin was replaced at baseline levels (0.25 mU·kg^–1·min^–1) and plasma glucose clamped at 5–6 mmol/liter. Overall, there were no significant statistical differences in GH responses determined as either GH peak concentrations, integrated levels of GH, or secretory burst mass of GH during the experimental protocol. In contrast, plasma glucagon concentrations were significantly increased during glibenclamide and repaglinide exposure. The present experimental design does not support the hypothesis that acute administration of pharmacological doses of the oral antihyperglycemic agents glibenclamide and repaglinide per se enhance GH release in humans. Additionally, this study shows that these potassium channel inhibitors seem to stimulate glucagon secretion in people who have severe intraislet insulin deficiency (e.g. type 1 diabetes). However, extrapolation of our findings to type 2 diabetic individuals should be done with some caution.

The study was supported in part by Novo Nordisk A/S and the Danish Diabetes Association.

Abbreviations: AUC, Area under curve; C_max, maximal concentration; NEFA, nonesterified fatty acid; NS, not significant; SU, sulfonylurea; SUR, sulfonylurea receptor.

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