TCF7L2 Genetic Variation Augments Incretin Resistance and Influences Response to a Sulfonylurea and Metformin: The Study to Understand the Genetics of the Acute Response to Metformin and Glipizide in Humans (SUGAR-MGH)

Abstract

Objective: The rs7903146 T allele in transcription factor 7 like 2 (TCF7L2) is strongly associated with type 2 diabetes (T2D), but the mechanisms for increased risk remain unclear. We evaluated the physiologic and hormonal effects of TCF7L2 genotype before and after interventions that influence glucose physiology.

Research design and methods: We genotyped rs7903146 in 608 individuals without diabetes and recorded biochemical data before and after 1) one dose of glipizide (5 mg) on visit 1 and 2) a 75-g oral glucose tolerance test (OGTT) performed after administration of metformin 500 mg twice daily over 2 days. Incretin levels were measured in 150 of the 608 participants.

Results: TT risk-allele homozygotes had 1.6 mg/dL higher baseline fasting glucose levels and 2.5 pg/mL lower glucagon levels per T allele than carriers of other genotypes at baseline. In a subset of participants, the T allele was associated with higher basal glucagon-like peptide 1 (GLP-1) levels at visit 1 (β = 1.52, P = 0.02 and β = 0.96, P = 0.002 for total and active GLP-1, respectively), and across all points of the OGTT after metformin administration. Regarding drug response, the T allele was associated with a shorter time (β = -7.00, P = 0.03) and a steeper slope (β = 0.23, P = 0.04) to trough glucose levels after glipizide administration, and lower visit 2 fasting glucose level adjusted for visit 1 fasting glucose level (β = -1.02, P = 0.04) and a greater decline in glucose level between visits (β = -1.61, P = 0.047) after metformin administration.

Conclusions: Our findings demonstrate that common variation at TCF7L2 influences acute responses to both glipizide and metformin in people without diabetes and highlight altered incretin signaling as a potential mechanism by which TCF7L2 variation increases T2D risk.

Trial registration: ClinicalTrials.gov NCT01762046.

Figure 1

A: Change in plasma insulin across genotypes at visit 1 after glipizide administration. B: Change in plasma glucose across genotypes at visit 1 after glipizide administration. C: Change in plasma glucagon across genotypes at visit 1 after glipizide administration. Data depict mean ± SEM, n = 608 (CC = 311, CT = 242, TT = 55).

Figure 2

A and B: n = 608 (CC = 311, CT = 242, TT = 55). A: Change in plasma glucose across the various time points of the OGTT at visit 2 after four doses of metformin. B: Change in plasma insulin across the various time points of the OGTT at visit 2 after four doses of metformin. C–E: n = 150 (CC = 50, CT = 50, TT = 50). C: Change in plasma GLP-1 (total) across the various time points of the OGTT at visit 2 after four doses of metformin. D: Change in plasma GLP-1 (active) across the various time points of the OGTT at visit 2 after four doses of metformin. E: Change in plasma GIP across the various time points of the OGTT at visit 2 after four doses of metformin. Data depict mean ± SEM.