metformin monotherapy, a bile acid called sequestrant colesevelam can improve your wellness by reducing fasting and your postprandial glucose concentrations, without having an effect on your insulin concentration, secretion, or action.
For the study, which was led by Galina Smushkin, MD, of the Mayo Clinic College of Medicine in Rochester, Minnesota, 38 patients with type 2 diabetes who were taking metformin monotherapy took part in a double-blind, placebo-controlled, parallel-group study of the effect of bile acid sequestration with colesevelam on glucose metabolism. The team used a labelled triple-tracer mixed meal to measure the rate of meal appearance, endogenous glucose production, and glucose disappearance, and gave this to the participants before and after 12 weeks of colesevelam or placebo.
The results were that colesevelam treatment related to significantly lower fasting and postprandial glucose concentrations, without any change in insulin concentration, secretion, or action, or postprandial concentrations of glucagon-like peptide-1 (GLP-1), endogenous glucose production or glucose disappearance. However, it was associated with a decrease in the rate of meal appearance.
The authors wrote, ‘In this experiment, we demonstrate an effect of colesevelam on both fasting and postprandial glucose concentrations. Measurement of insulin secretion and action using the oral labelled and unlabelled minimal model failed to show a significant effect on insulin secretion and action. Moreover, there was no evidence that glucose lowering is produced by alterations in GLP-1 concentrations.’
Yet it’s worth noting that Daiichi-Sankyo, which markets colesevelam, provided grant support for the study, and one author admitted to having financial ties to pharmaceutical companies, including Daiichi-Sankyo.