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Bile Acid Sequestrants: Glucose-Lowering Mechanisms and Efficacy in Type 2 Diabetes

  • Pharmacologic Treatment of Type 2 Diabetes (A Vella, Section Editor)
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Abstract

Bile acids are synthesized in the liver from cholesterol and have traditionally been recognized for their role in absorption of lipids and in cholesterol homeostasis. In recent years, however, bile acids have emerged as metabolic signaling molecules that are involved in the regulation of lipid and glucose metabolism, and possibly energy homeostasis, through activation of the bile acid receptors farnesoid X receptor (FXR) and TGR5. Bile acid sequestrants (BASs) constitute a class of drugs that bind bile acids in the intestine to form a nonabsorbable complex resulting in interruption of the enterohepatic circulation. This increases bile acid synthesis and consequently reduces serum low-density lipoprotein cholesterol. Also, BASs improve glycemic control in patients with type 2 diabetes. Despite a growing understanding of the impact of BASs on glucose metabolism, the mechanisms behind their glucose-lowering effect in patients with type 2 diabetes remain unclear. This article offers a review of the mechanisms behind the glucose-lowering effect of BASs, and the efficacy of BASs in the treatment of type 2 diabetes.

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Conflict of Interest

M. Hansen has received an unrestricted educational stipend from the Novo Nordisk Foundation. D. P. Sonne has received an unrestricted educational stipend from the Novo Nordisk Foundation. F. K. Knop has received research funding from Sanofi-Aventis Deutschland GmbH and lecture fees from AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Eli Lilly and Company, Gilead Sciences, Merck Sharp & Dohme, Novo Nordisk, Ono Pharmaceuticals, Sanofi, and Zealand Pharma. He is part of the Advisory Boards of Eli Lilly Denmark, Bristol-Myers Squibb/AstraZeneca, and Zealand Pharma. He has consulted for AstraZeneca, Gilead Sciences, Novo Nordisk, Ono Pharmaceuticals, and Zealand Pharma. He also has 2 pending patents.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Diabetes Research Division, Department of Medicine, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, DK-2900, Hellerup, Denmark

    Morten Hansen, David P. Sonne & Filip K. Knop

  2. Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Morten Hansen, David P. Sonne & Filip K. Knop

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  1. Morten Hansen
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Correspondence to Filip K. Knop.

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This article is part of the Topical Collection on Pharmacologic Treatment of Type 2 Diabetes

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Hansen, M., Sonne, D.P. & Knop, F.K. Bile Acid Sequestrants: Glucose-Lowering Mechanisms and Efficacy in Type 2 Diabetes. Curr Diab Rep 14, 482 (2014). https://doi.org/10.1007/s11892-014-0482-4

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