Effects of proximal and distal enteral glucose infusion on cardiovascular response in health and type 2 diabetes.

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Exposure of the small intestine to nutrients frequently leads to marked reductions in blood pressure (BP) in type 2 diabetes (T2DM). It remains unclear whether the region of the gut exposed to nutrients influences postprandial cardiovascular responses.To evaluated the cardiovascular responses to proximal and distal small intestinal glucose infusion in health and T2DM.Double-blind, randomised, crossover design.Single center in Australia.10 healthy subjects and 10 T2DM patients.Volunteers were studied on two occasions, when a transnasal catheter was positioned with infusion ports opening 13cm and 190cm beyond the pylorus. 30g glucose was infused into either site and 0.9% saline into the alternate site over 60min.BP, heart rate (HR) and superior mesenteric artery (SMA) blood flow were measured over 180min.Systolic BP was unchanged in response to both infusions in health, but decreased in T2DM, with a greater reduction after proximal vs. distal infusion (all P≤0.01). The increment in HR did not differ between treatments in health, but was greater after distal vs. proximal infusion in T2DM (P=0.02). The increases in SMA blood flow were initially greater, but less sustained, with proximal vs. distal infusion in health (P<0.001), a pattern less evident in T2DM.In T2DM, postprandial hypotension may be mitigated by diversion of nutrients from the proximal to the distal small intestine.

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