Physiology of the small intestine in the glycemic control and the treatment of diabetes mellitus

Abstract

Gycemic control is essential for patients with diabetes mellitus. To better understand the pathophysiology of diabetes, we need to know how blood glucose level is regulated. Alpha-glucosidase inhibitors are well known as antidiabetic drugs. These drugs inhibit alpha-glucosidase to delay the absorption of glucose in the small intestinal mucosa. Thus, regulation of enzyme activity in the small intestinal mucosa is involved in the glycemic control in diabetes mellitus. Apolipoprotein A-IV produced in the small intestinal mucosal cells acts in the brain to inhibit feeding and delay gastric emptying. Suppression of feeding and gastric emptying might suggest that apolipoprotein A-IV may be relevant for diabetic patients because inhibition of energy intake and delayed absorption of glucose may be favorable for diabetic patients. We therefore raise a possibility that apolipoprotein may be a novel molecule that improves glycemic control.