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Aims/Introduction: Glucose‐dependent insulinotropic polypeptide (GIP) and glucagon‐like peptide‐1 (GLP‐1) are important incretin hormones. They are released from the gut after meal ingestion and potentiate glucose‐stimulated insulin secretion. Their release after meal ingestion and oral glucose are well established and have been characterized previously. During recent years, knowledge of other regulatory aspects that potentially may affect GIP and GLP‐1 secretion after meal ingestion have also begun to emerge. Here, the results of human studies on these novel aspects of meal‐ and nutrient‐stimulated incretin hormone secretion are reviewed. Materials and Methods: The human literature was revisited by identifying articles in PubMed using key words GIP, GLP‐1, secretion, meal, and nutrients. Results: The results show that all macronutrients individually stimulate GIP and GLP‐1 secretion. However, there was no synergistic action when given in combination. A pre‐load 30 min before a meal augments the GIP and GLP‐1 response. GIP and GLP‐1 secretion have a diurnal variation with a higher response to an identical meal in the morning than in the afternoon. There is no difference in GIP and GLP‐1 secretion whether a meal is ingested slowly or rapidly. GIP and GLP‐1 secretion after dinner are the same whether or not breakfast and lunch have been ingested. The temperature of the food may be of importance for the incretin hormone response. Conclusions: These novel findings have increased our knowledge on the regulation of the complexity of the incretin system and are also important knowledge when designing future studies. [ABSTRACT FROM AUTHOR]

Aim: Dipeptidyl peptidase‐4 (DPP‐4) inhibition has effects on both fasting and postprandial glucose. However, the extent of this effect over the whole day and whether different DPP‐4 inhibitors have the same effects have not been established. We therefore explored the whole day effects of three different DPP‐4 inhibitors versus placebo on glucose, islet and incretin hormones after ingestion of breakfast, lunch and dinner in subjects with metformin‐treated and well‐controlled type 2 diabetes. Methods: The study was single‐centre and crossover designed, involving 24 subjects [12 men, 12 women, mean age 63 years, body mass index 31.0 kg/m2, glycated haemoglobin 44.7 mmol/mol (6.2%)], who underwent four test days in random order. Each whole day test included ingestion of standardized breakfast (525 kcal), lunch (780 kcal) and dinner (560 kcal) after intake of sitagliptin (100 mg) or vildagliptin (50 mg twice), or saxagliptin (5 mg) or placebo. Results: Compared with placebo, DPP‐4 inhibition reduced glucose levels, increased beta‐cell function (insulin secretory rate in relation to glucose), suppressed glucagon, increased intact glucagon‐like‐peptide‐1 (GLP‐1) and glucose‐dependent insulinotropic polypeptide (GIP) but suppressed total GLP‐1 and GIP after all three meals. The effects were sustained throughout the daytime period with similar changes after each meal and did not differ between the DPP‐4 inhibitors. Conclusions: DPP‐4 inhibition has persistent daytime effects on glucose, islet and incretin hormones with no difference between three different DPP‐4 inhibitors. [ABSTRACT FROM AUTHOR]

Postpartum follow up of patients with gestational diabetes (GDM) is of great importance due to the elevated risk of development of type 2 diabetes after pregnancy. The Swedish National Board of Health and Welfare (Socialstyrelsen) concludes that follow-up is of utmost importance, but there are no guidelines of implementation. At Helsingborg Hospital all patients with insulin and/or metformin treated GDM are offered follow-up oral glucose tolerance test (OGTT) at 3 and 12 months postpartum. During the Covid-19 pandemic patients were not offered OGTT but instead instructed to measure glucose levels at home seven times a day for two days and report the results. In this study we compared the results of patients that had undergone OGTT, and those who had measured glucose levels at home. We found that at-home measurements were flawed in detecting impaired glucose tolerance, and significantly fewer cases of diabetes were detected.

Fasting during the month of Ramadan constitutes one of the five pillars of Islam. Islam is the second largest religion in Sweden. Fasting starts as the sun rises and the latest meal intake (Suhoor) is before the sun rises. The first meal intake (Iftar) is at the end of the fasting period, which is at sunset. Based on epidemiological data it is known that a large proportion of persons with diabetes, both type 1 and type 2, fast for at least fifteen days during Ramadan. However, fasting is not recommended in case of  type 1 diabetes or in pregnant women with diabetes, neither in people with type 2 diabetes and multiple complications. Guidelines for the management of diabetes during Ramadan are still limited in Sweden. This review aims to summarize the EASD/ADA guidelines regarding the management of people with diabetes before, during and after Ramadan fasting.