JP2004026678A - Therapeutic agent for type 2 diabetes - Google Patents

Therapeutic agent for type 2 diabetes Download PDF

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Publication number
JP2004026678A
JP2004026678A JP2002182280A JP2002182280A JP2004026678A JP 2004026678 A JP2004026678 A JP 2004026678A JP 2002182280 A JP2002182280 A JP 2002182280A JP 2002182280 A JP2002182280 A JP 2002182280A JP 2004026678 A JP2004026678 A JP 2004026678A
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Japan
Prior art keywords
amino
diabetes
therapeutic agent
type
glp
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JP2002182280A
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Japanese (ja)
Inventor
Tomio Takeuchi
竹内 富雄
Yasuhiko Muraoka
村岡 靖彦
Tetsuo Akiyama
秋山 哲男
Masatoshi Abe
阿部 雅年
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Microbial Chemistry Research Foundation
Nippon Kayaku Co Ltd
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Microbial Chemistry Research Foundation
Nippon Kayaku Co Ltd
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Priority to JP2002182280A priority Critical patent/JP2004026678A/en
Priority to PCT/JP2003/007928 priority patent/WO2004000327A1/en
Publication of JP2004026678A publication Critical patent/JP2004026678A/en
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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/66Phosphorus compounds
    • A61K31/675Phosphorus compounds having nitrogen as a ring hetero atom, e.g. pyridoxal phosphate
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00Drugs for disorders of the metabolism
    • A61P3/08Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics

Abstract

<P>PROBLEM TO BE SOLVED: To obtain a therapeutic agent for type 2 diabetes comprising a sulfostin-related compound or its pharmacologically acceptable salt as an active ingredient. <P>SOLUTION: This therapeutic agent for the type 2 diabetes comprises the sulfostin-related compound represented by formula (1)[wherein, (n) denotes an integer of 0-3] or its pharmacologically acceptable salt as an active ingredient. <P>COPYRIGHT: (C)2004,JPO

Description

【0001】
【発明の属する技術分野】
本発明は、スルフォスチン関連化合物またはその薬理学上許容される塩を有効成分とする2型糖尿病に対する治療剤に関する。
【0002】
【従来の技術】
血中のインスリン分泌刺激因子GLP−1が減少し、膵臓におけるインスリン分泌の減少を来し、生命を脅かす危険に陥ることが知られている。これら血中におけるGLP−1量減少症状の病態としては2型糖尿病が知られている。
【0003】
血中におけるGLP−1量減少の機序は、GLP−1がジペプチジルペプチダーゼIV(Diabetes,Vol.47,p1253,1998)によって不活化されることが知られている。
【0004】
GLP−1量減少症の治療剤として既存のものはなく、ジペプチジルペプチダーゼIV阻害剤であるP32/98(2(S)−Amino−3(S)−methyl−1−(3−thiazolidinyl)pentan−1−one fumarate; Drugs of the Future,Vol.26,p859,2001)およびNVP−DPP728(S)−1−{2−[2−(4−Cyano−phenylamino)−ethylamino]−acetyl}−pyrrolidine−2−carbonitrile; Annual Reports In Medicinal Chemistry,Vol.36,p191,2001)などが応用されつつある。
【0005】
スルフォスチンはストレプトミセス(Streptomyses)属に属す微生物を培養することにより得られ、また類縁化合物も化学的合成によって得られ、これらスルフォスチン関連化合物はジペプチジルペプチダーゼIV阻害活性作用を有したことにより、例えば免疫調節剤、ホルモン調節剤、抗HIV薬、抗アレルギー薬、抗炎症薬、抗リウマチ薬などとしての生理活性物質として期待されている(WO 99/25719、特開2000−327689)。
【0006】
【発明が解決しようとする課題】
本発明は、新たな2型糖尿病に対する治療剤の提供を目的とする。
【0007】
【課題を解決するための手段】
本発明者らは鋭意研究を行った結果、イン・ビトロにおいて、一般式(1)で表されるスルフォスチン関連化合物が、ジペプチジルペプチダーゼIVによるヒトGLP−1の分解を阻害したことおよび対照剤P32/98に比べ約10倍強く阻害したことを確認し、GLP−1減少阻害剤となること、さらには2型糖尿病治療剤の有効成分となることを見出した。なお、前記のスルフォスチン関連の公報(WO 99/25719、特開2000−327689)には、2型糖尿病に対して治療効果を有する旨の示唆はなく、本発明者らによって初めて2型糖尿病治療剤としての有用性を見出したものである。
【0008】
すなわち、本発明は次の(1)〜(3)に関するものである。
(1).一般式(1)
【0009】
【化2】

Figure 2004026678
〔式中、nは0〜3の整数を示す。〕
で表わされるスルフォスチン関連化合物またはその薬理学上許容される塩を有効成分とする2型糖尿病治療剤。
(2). 一般式(1)に於いてn=1〜3を示す化合物である、前記1項に記載の治療剤。
(3). 2型糖尿病がゴルカゴン様ペプチド−1(GLP−1)減少症である、1または2項記載の治療剤。
【0010】
【発明の実施の形態】
本発明に於いて2型糖尿病治療剤とは、該薬剤を人体や動物に投与することにより、血中におけるジペプチジルペプチダーゼIVを阻害し、インスリン刺激因子GLP−1分解を阻害し、GLP−1量の減少を抑制して、インスリン分泌刺激活性を維持することにより2型糖尿病を治療する薬剤を示す。
【0011】
本発明で使用する一般式(1)で表されるスルフォスチン関連化合物はWO99/25719公報 ないしは特開2000−327689公報に記載の製造方法に従って製造して得ることが出来る。
【0012】
一般式(1)で表される化合物に於いて、nは0〜3の整数を示し、好ましくは1〜3を示す化合物が好ましい。また、一般式(1)で表される化合物は、光学活性部位をアミノ基の付け根の環構成炭素(C)および燐(P)に有しており、各々の光学異性体およびラセミ体も本願発明の化合物として含まれる。
【0013】
例えば、一般式(1)で表される化合物の具体例は次のようなものである。
1. 3(S)−アミノ−1−((S)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン
2. 3(S)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン
(スルフォスチンと命名されている)
3. 3(R)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン
4. 3(R)−アミノ−1−((S)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン
【0014】
5. 3(S)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−カプロラクタム
6. 3(S)−アミノ−1−((S)−アミノ(スルホアミノ)ホスフィニル)−2−カプロラクタム
7. 3(S)−アミノ−1−((S)−アミノ(スルホアミノ)ホスフィニル)−2−ピロリドン
8. 3(S)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピロリドン
【0015】
また、本発明に於いて、一般式(1)で表される化合物を2型糖尿病治療剤として用いる際は、薬理学上許容される塩として投与しても良く、かかる塩としては、例えば塩酸、硫酸、燐酸等との無機酸塩、p−トルエンスルホン酸等の有機酸塩及びNa, K, Ca等の無機金属塩、メチルアミン、エチルアミン、ジエタノールアミン等の有機アミン塩が挙げられる。
【0016】
上記のスルフォスチン関連化合物またはその薬理学上許容される塩を本発明の2型糖尿病治療剤として適用する場合、製剤化及び投与方法としては従来公知の種々の方法を利用できる。投与方法としては注射、経口、直腸投与などが可能である。製剤形態としては注射剤、粉末剤、顆粒剤、錠剤、座剤などの形態を採りえる。
【0017】
製剤化の際にはスルフォスチン関連化合物に悪影響を与えない限り、医薬用に用いられる種々の補助剤、すなわち、担体やその他の助剤、例えば安定剤、防腐剤、無痛化剤、乳化剤等を必要に応じて使用することが出来る。製剤中のスルフォスチン関連化合物またはその薬理学上許容される塩の含量は製剤形態等により広範囲に変えることが可能であり、一般的には製剤はスルフォスチンまたはその塩を0.01〜100重量%、好ましくは0.1〜70重量%含み、残りとしては通常医薬用に使用される担体、その他の補助剤を含む。
【0018】
スルフォスチン関連化合物またはその塩の投与量は症状により異なるが、成人1人1日当たり0.01〜800mg程度である。連投を必要とする場合には、1日当たりの使用量を抑えることが望ましい。
【0019】
【実施例】
次に、実施例として本願発明による薬理実験例及び製剤例を示すが本願発明ではこれらに限定されるものではない。
【0020】
実験例1(GLP−1分解阻害試験)
実験方法及び結果:
イン・ビトロにおけるジペプチジルペプチダーゼIVによるヒトGLP−1分解に対するスルフォスチン[3(S)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン] (化合物2)および[3(R)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン] (化合物3)の阻害効果を、O‘arteらの方法(Biophysica Biochemica et Acta,Vol.1474,p13,2000)に準じて行った。
対照薬としてジペプチジルペプチダーゼIV阻害剤P32/98((2(S)−Amino−3(S)−methyl−1−(3−thiazolidinyl)pentan−1−one fumarate)を用いた。P32/98は文献(Drugs of the Future,Vol.26,p859,2001)記載の製造方法に準じて合成して得ることができる。
【0021】
検体はあらかじめ精製水に溶解した後、測定した。
アッセイはヘペス緩衝液0.015mlに0.5mMヒトGLP−1(7−36 Amide、ペプチド研)0.006mlとジペプチジルペプチダーゼIVを含む水溶液0.003mlを加え、37℃、10分間アルミ高温槽で加温し、検体0.006mlを加え、37℃で20分間反応させた。酵素反応後、直ちにあらかじめ30%アセトニトリル−トリフルオロ酢酸水溶液(pH2.0)で平衡化したHPLC用の逆相ODSカラム(PEGASIL、4.6×250mm、センシュー科学製)に吸着させ、アセトニトリルの濃度を直線勾配的に45%まで上昇させた。GLP−1(7−36アミド)およびその分解産物GLP−1(9−36アミド)の検出は210nmで測定した。GLP−1分解阻害率は分解産物GLP−1(9−36アミド)のピーク面積の減少率から算出し、各検体につき独立した3回の測定から得られた阻害率を平均した。
その結果を表1に示した。
【0022】
Figure 2004026678
【0023】
すなわち、スルフォスチン[3(S)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン]および[3(R)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン]はともに0.0001mg/mlにおいてジププチジルペプチダーゼIVによるGLP−1の分解を90%以上強く阻害していた。0.00001mg/mlにおいてそれぞれ55.6%および31.8%の阻害がみられ、0.000001mg/mlでは阻害は弱く、それぞれ20%未満であった。対照薬であるP32/98は0.001mg/mlにおいて84.9%と強く阻害し、0.0001mg/mlにおいて42.8%の阻害がみられ、0.00001mg/mlでは19.6%と弱いものであった。このことから、スルフォスチン[3(S)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン]および[3(R)−アミノ−1−((R)−アミノ(スルホアミノ)ホスフィニル)−2−ピペリドン]はともに対照薬P32/98に比べ同程度の阻害を示す濃度が10倍違い、10倍強力にジペプチジルペプチダーゼIVによるGLP−1の分解を阻害することが明らかとなった。
【0024】
製剤例1
本発明化合物スルフォスチンを30%(W/V)ポリエチレングリコール400を含む生理食塩水に溶解して該化合物の0.05%溶液を調整し、滅菌濾過して、バイアル1個当たり15mgの化合物を含有する静脈注入用製剤を製造した。
【0025】
製剤例2
スルフォスチン30重量部、結晶乳糖120部、結晶セルロース147部及びステアリン酸マグネシウム3部をV型混合機で混合した後、打錠して1錠300mgの錠剤を得た。
【0026】
【発明の効果】
本発明により、スルフォスチン関連化合物はジペプチジルペプチダーゼIVによるGLP−1の分解を阻害し、また対照薬P32/92よりも約10倍強く阻害することが確認され、2型糖尿病治療剤として有用であることが判明した。[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a therapeutic agent for type 2 diabetes comprising a sulfostine-related compound or a pharmacologically acceptable salt thereof as an active ingredient.
[0002]
[Prior art]
It is known that the insulin secretion stimulating factor GLP-1 in the blood decreases, resulting in a decrease in insulin secretion in the pancreas, which poses a life-threatening danger. Type 2 diabetes is known as a pathological condition of the GLP-1 level decrease in blood.
[0003]
It is known that the mechanism of the decrease in the amount of GLP-1 in blood is that GLP-1 is inactivated by dipeptidyl peptidase IV (Diabetes, Vol. 47, p1253, 1998).
[0004]
There is no existing therapeutic agent for GLP-1 hypovolemia, and P32 / 98 (2 (S) -Amino-3 (S) -methyl-1- (3-thiazolidinyl) pentan, a dipeptidyl peptidase IV inhibitor. Drugs of the Future, Vol. 26, p859, 2001) and NVP-DPP728 (S) -1- {2- [2- (4-Cyano-phenylamino) -ethylamine] -pyrrolidine. -2-carbonitrile; Annual Reports In Medicinal Chemistry, Vol. 36, p191, 2001) and the like are being applied.
[0005]
Sulfostin can be obtained by culturing a microorganism belonging to the genus Streptomyces, and analogous compounds can also be obtained by chemical synthesis. These sulfostine-related compounds have a dipeptidyl peptidase IV inhibitory activity, for example, because of their immunity. It is expected as a physiologically active substance as a regulator, hormone regulator, anti-HIV drug, anti-allergic drug, anti-inflammatory drug, anti-rheumatic drug, etc. (WO 99/25719, JP-A-2000-327689).
[0006]
[Problems to be solved by the invention]
An object of the present invention is to provide a new therapeutic agent for type 2 diabetes.
[0007]
[Means for Solving the Problems]
The present inventors have conducted intensive studies and as a result, in vitro, found that the sulfostine-related compound represented by the general formula (1) inhibited the degradation of human GLP-1 by dipeptidyl peptidase IV and showed that the control agent P32 It was confirmed that the inhibition was about 10 times stronger than that of / 98, and it was found to be a GLP-1 decrease inhibitor and further to be an active ingredient of a therapeutic agent for type 2 diabetes. The above-mentioned publication relating to sulfostin (WO 99/25719, Japanese Patent Application Laid-Open No. 2000-327689) does not suggest that it has a therapeutic effect on type 2 diabetes, and for the first time, the present inventors have proposed a therapeutic agent for type 2 diabetes. Was found to be useful.
[0008]
That is, the present invention relates to the following (1) to (3).
(1). General formula (1)
[0009]
Embedded image
Figure 2004026678
[In formula, n shows the integer of 0-3. ]
A therapeutic agent for type 2 diabetes, comprising a sulfostine-related compound represented by the formula or a pharmacologically acceptable salt thereof as an active ingredient.
(2). 2. The therapeutic agent according to the above item 1, which is a compound showing n = 1 to 3 in the general formula (1).
(3). 3. The therapeutic agent according to claim 1 or 2, wherein the type 2 diabetes is golcagon-like peptide-1 (GLP-1) decrease.
[0010]
BEST MODE FOR CARRYING OUT THE INVENTION
In the present invention, the therapeutic agent for type 2 diabetes refers to a dipeptidyl peptidase IV in blood, an insulin stimulating factor GLP-1 degradation, and a GLP-1 by administering the drug to a human body or an animal. [Fig. 4] Fig. 4 shows an agent for treating type 2 diabetes by suppressing a decrease in the amount and maintaining insulin secretion stimulating activity.
[0011]
The sulfostine-related compound represented by the general formula (1) used in the present invention can be obtained by producing according to the production method described in WO99 / 25719 or JP-A-2000-327689.
[0012]
In the compound represented by the general formula (1), n represents an integer of 0 to 3, preferably 1 to 3. Further, the compound represented by the general formula (1) has an optically active site at the ring-constituting carbon (C) and phosphorus (P) at the base of the amino group. Included as compounds of the invention.
[0013]
For example, specific examples of the compound represented by the general formula (1) are as follows.
1. 1. 3 (S) -amino-1-((S) -amino (sulfoamino) phosphinyl) -2-piperidone 3 (S) -amino-1-((R) -amino (sulfoamino) phosphinyl) -2-piperidone (named sulfostine)
3. 3. 3 (R) -amino-1-((R) -amino (sulfoamino) phosphinyl) -2-piperidone 3 (R) -amino-1-((S) -amino (sulfoamino) phosphinyl) -2-piperidone
5. 5. 3 (S) -amino-1-((R) -amino (sulfoamino) phosphinyl) -2-caprolactam 6. 3 (S) -amino-1-((S) -amino (sulfoamino) phosphinyl) -2-caprolactam 7. 3 (S) -amino-1-((S) -amino (sulfoamino) phosphinyl) -2-pyrrolidone 3 (S) -amino-1-((R) -amino (sulfoamino) phosphinyl) -2-pyrrolidone
In addition, in the present invention, when the compound represented by the general formula (1) is used as a therapeutic agent for type 2 diabetes, it may be administered as a pharmacologically acceptable salt. And inorganic acid salts such as p-toluenesulfonic acid, inorganic metal salts such as Na, K and Ca, and organic amine salts such as methylamine, ethylamine and diethanolamine.
[0016]
When the above-mentioned sulfostine-related compound or a pharmacologically acceptable salt thereof is applied as the therapeutic agent for type 2 diabetes of the present invention, conventionally known various methods can be used for preparation and administration. As an administration method, injection, oral administration, rectal administration and the like are possible. The preparation may take the form of injections, powders, granules, tablets, suppositories and the like.
[0017]
Various auxiliaries used in medicine, such as carriers and other auxiliaries, such as stabilizers, preservatives, soothing agents, emulsifiers, etc., are required as long as they do not adversely affect the sulfostine-related compounds during formulation. Can be used according to The content of the sulfostine-related compound or a pharmacologically acceptable salt thereof in the preparation can be widely varied depending on the preparation form and the like. Generally, the preparation contains 0.01 to 100% by weight of sulfostine or a salt thereof, It preferably contains 0.1 to 70% by weight, and the rest contains carriers and other auxiliaries usually used for medicine.
[0018]
The dosage of the sulfostine-related compound or a salt thereof varies depending on the condition, but is about 0.01 to 800 mg per adult per day. If continuous throwing is required, it is desirable to reduce the daily usage.
[0019]
【Example】
Next, pharmacological experimental examples and preparation examples according to the present invention will be described as examples, but the present invention is not limited thereto.
[0020]
Experimental Example 1 (GLP-1 degradation inhibition test)
Experimental method and results:
Sulfostin [3 (S) -amino-1-((R) -amino (sulfoamino) phosphinyl) -2-piperidone] for human GLP-1 degradation by dipeptidyl peptidase IV in vitro (compound 2) and [3 ( R) -Amino-1-((R) -amino (sulfoamino) phosphinyl) -2-piperidone] (Compound 3) was evaluated by the method of O'art et al. (Biophysica Biochemica et Acta, Vol. 1474, p13, p. 2000).
As a control, dipeptidyl peptidase IV inhibitor P32 / 98 ((2 (S) -Amino-3 (S) -methyl-1- (3-thiazolidinyl) pentan-1-one fumarate) was used. It can be obtained by synthesis according to the production method described in the literature (Drugs of the Future, Vol. 26, p859, 2001).
[0021]
The sample was previously dissolved in purified water and then measured.
In the assay, 0.006 ml of 0.5 mM human GLP-1 (7-36 Amide, Peptide Laboratories) and 0.003 ml of an aqueous solution containing dipeptidyl peptidase IV were added to 0.015 ml of Hepes buffer, and an aluminum high-temperature bath at 37 ° C. for 10 minutes. Then, 0.006 ml of the sample was added, and the mixture was reacted at 37 ° C for 20 minutes. Immediately after the enzymatic reaction, the mixture was immediately adsorbed to a reverse-phase ODS column for HPLC (PEGASIL, 4.6 × 250 mm, manufactured by Senshu Kagaku) equilibrated with a 30% acetonitrile-trifluoroacetic acid aqueous solution (pH 2.0), and the concentration of acetonitrile was measured. Was increased linearly to 45%. Detection of GLP-1 (7-36 amide) and its degradation product GLP-1 (9-36 amide) was measured at 210 nm. The GLP-1 degradation inhibition rate was calculated from the reduction rate of the peak area of the degradation product GLP-1 (9-36 amide), and the inhibition rates obtained from three independent measurements for each sample were averaged.
The results are shown in Table 1.
[0022]
Figure 2004026678
[0023]
That is, sulfostin [3 (S) -amino-1-((R) -amino (sulfoamino) phosphinyl) -2-piperidone] and [3 (R) -amino-1-((R) -amino (sulfoamino) phosphinyl) ) -2-Piperidone] strongly inhibited the degradation of GLP-1 by dipeptidyl peptidase IV by 90% or more at 0.0001 mg / ml. At 0.00001 mg / ml there was 55.6% and 31.8% inhibition, respectively, and at 0.000001 mg / ml the inhibition was weak, each less than 20%. The control drug P32 / 98 strongly inhibited 84.9% at 0.001 mg / ml, showed 42.8% inhibition at 0.0001 mg / ml, and 19.6% at 0.00001 mg / ml. It was weak. This indicates that sulfostins [3 (S) -amino-1-((R) -amino (sulfoamino) phosphinyl) -2-piperidone] and [3 (R) -amino-1-((R) -amino (sulfoamino) ) Phosphinyl) -2-piperidone] showed a 10-fold difference in concentration showing the same level of inhibition as the control drug P32 / 98, and clearly inhibited GLP-1 degradation by dipeptidyl peptidase IV by 10-fold. became.
[0024]
Formulation Example 1
The compound of the present invention, sulfostine, is dissolved in physiological saline containing 30% (W / V) polyethylene glycol 400 to prepare a 0.05% solution of the compound, sterile filtered, and contains 15 mg of the compound per vial. A formulation for intravenous infusion was prepared.
[0025]
Formulation Example 2
30 parts by weight of sulfostine, 120 parts of crystalline lactose, 147 parts of crystalline cellulose, and 3 parts of magnesium stearate were mixed with a V-type mixer, and the mixture was tabletted to obtain a tablet of 300 mg per tablet.
[0026]
【The invention's effect】
According to the present invention, it has been confirmed that a sulfostine-related compound inhibits the degradation of GLP-1 by dipeptidyl peptidase IV and inhibits about 10 times more strongly than the control drug P32 / 92, and is useful as a therapeutic agent for type 2 diabetes. It has been found.

Claims (3)

一般式(1)
Figure 2004026678
〔式中、nは0〜3の整数を示す。〕
で表わされるスルフォスチン関連化合物またはその薬理学上許容される塩を有効成分とする2型糖尿病治療剤。
General formula (1)
Figure 2004026678
[In formula, n shows the integer of 0-3. ]
A therapeutic agent for type 2 diabetes, comprising a sulfostine-related compound represented by the formula or a pharmacologically acceptable salt thereof as an active ingredient.
一般式(1)に於いてn=1〜3を示す化合物である、請求項1記載の治療剤。The therapeutic agent according to claim 1, which is a compound showing n = 1 to 3 in the general formula (1). 2型糖尿病がインスリン刺激因子ゴルカゴン様ペプチド−1(GLP−1)減少症である、請求項1または2記載の治療剤。The therapeutic agent according to claim 1 or 2, wherein the type 2 diabetes is insulin stimulating factor golgagon-like peptide-1 (GLP-1) decrease.
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