Ingestion of fat before a carbohydrate meal markedly slows GE and attenuates the postprandial rises in glucose, insulin, and GIP, but stimulates GLP-1, in type 2 diabetes.

OBJECTIVE -To define the predictors of the rate of gastric emptying in patients with diabetes.RESEARCH DESIGN AND METHODS -A total of 101 outpatients with diabetes (79 type 1 and 22 type 2) underwent measurements of gastric emptying of a solid/liquid meal (scintigraphy), upper gastrointestinal symptoms (questionnaire), glycemic control (blood glucose concentrations during gastric emptying measurement), and autonomic nerve function (cardiovascular reflexes).RESULTS -The gastric emptying of solid and/or liquid was delayed in 66 (65%) patients. Solid (retention at 100 min 64 Ϯ 3.2 vs. 50.2 Ϯ 3.6%, P Ͻ 0.005) and liquid (retention at 100 min 22.7 Ϯ 1.7 vs. 16.0 Ϯ 1.8%, P Ͻ 0.001) gastric emptying was slower in women than in men. Of all upper gastrointestinal symptoms (including nausea and vomiting), only abdominal bloating/fullness was associated with slower gastric emptying (P Ͻ 0.005). A multiple regression analysis demonstrated that both abdominal bloating/fullness and female sex were predictors of slower gastric emptying of both solids and liquids.CONCLUSIONS -We conclude that the presence of abdominal bloating/fullness but not any other upper gastrointestinal symptom is associated with diabetic gastroparesis and that gastric emptying is slower in diabetic women than in diabetic men. Diabetes Care 24:1264 -1269, 2001T he application of radioisotopic techniques to quantify gastric emptying has established that delayed gastric emptying (gastroparesis) occurs in 30 -50% of patients with longstanding diabetes (1-9), and diabetes and functional dyspepsia represent the two most common disorders associated with chronic gastroparesis (10). Diabetic gastroparesis is also recognized to represent a clinically important problem because of its potential sequelae of upper gastrointestinal symptoms, impaired oral drug absorption, and poor control of blood glucose concentrations (1). However, determinants of the rate of gastric emptying in patients with diabetes are controversial and poorly defined (1-9). Particularly, it is uncertain whether diabetic gastroparesis can be predicted based on clinical, demographic, or biochemical variables. In patients with diabetes, there is also a relatively poor relationship between gastric emptying of solids and gastric emptying of nutrient-containing liquid-meal components (2-4,7); delayed liquid gastric emptying frequently occurs and may be associated with normal solid emptying (7). Hence, the predictors of delay in liquid emptying may potentially differ from those associated with the delayed gastric emptying of solids.Previous studies have reported a relatively weak relationship between upper gastrointestinal symptoms and the rate of gastric emptying in patients with diabetes (2-7). Accordingly, it has been suggested that gastroparesis cannot be predicted based on symptoms and that objective measurement of gastric emptying is required for diagnosis (1,8). In most of these studies, symptoms have been evaluated using either a global symptom score and/or individual upper gastrointestinal symp...

In healthy subjects exogenous GLP-1 increases meal retention in the distal stomach and, even when administered in a "low" dose, frequently induces "gastroparesis," and the effects of GLP-1 on postprandial glycemia are predictable on the basis of its effect on GE, supporting the concept that GE is a major target mechanism for the clinical use of incretin mimetics.

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Pancreatic enzyme supplementation plays an important role in incretin secretion, gastric emptying, and postprandial hyperglycemia in CF.

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Background-Non-cholinergicnonadrenergic neural mechanisms involving nerves containing NO have been shown to modulate smooth muscle in the gastrointestinal tract, and it has been suggested that release from tonic NO inhibition may be important in the regulation of cyclical fasting small intestinal motility. Aims-To evaluate the role of NO mechanisms in the regulation of fasting small intestinal motor activity in humans using a specific NO synthase inhibitor, N Gmonomethyl-L-arginine ( L-NMMA). Conclusions-These observations suggest that NO mechanisms play a role in the regulation of fasting small intestinal motor activity in humans. (Gut 1999;44:72-76) Methods-In

Iberogast affects gastric motility in humans, probably in a region-dependent manner. The stimulation of gastric relaxation and antral motility may contribute to the reported therapeutic efficacy of Iberogast in FD.