A 25-Year Longitudinal Evaluation of Gastric Emptying in Diabetes

Chang, Jessica; Russo, Antonietta; Bound, Michelle J.; Rayner, Christopher K.; Jones, Karen L.; Horowitz, Michael

doi:10.2337/dc12-0028

Cited by 52 publications

(34 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…From a group of 86 patients assessed at a tertiary referral center, 20 patients, of whom 16 had type 1 DM, were reevaluated 12 years later and only 13 patients (12 had type 1 DM) were reevaluated approximately 25 years after the first study. 23, 29 While gastric emptying was not significantly different 25 years after the baseline assessment, correlation between initial and subsequent assessments was limited, as evidenced by a correlation coefficient of 0.56. 23 …”

Section: Natural History and Outcomesmentioning

confidence: 94%

Epidemiology and Natural History of Gastroparesis

Bharucha

2015

Gastroenterology Clinics of North America

View full text Add to dashboard Cite

Section: Natural History and Outcomesmentioning

confidence: 94%

Epidemiology and Natural History of Gastroparesis

Bharucha

2015

Gastroenterology Clinics of North America

View full text Add to dashboard Cite

“…Beginning with a cohort of 86 patients, 20 patients, of which 16 had type 1 DM, were reassessed 12 years later and 13 patients (12 had type 1 DM) were reassessed approximately 25 years after the first study. 14, 15 Despite a reduction in HbA1c, which was statistically significant at the earlier follow-up point (i.e., 8.4±2.3% at baseline, 7.6±1.3% at 12 years median), GE was stable over time when assessed for the entire group. Hence, the impact of improving control of glycemia on GE in type 2 DM is incompletely understood.…”

Section: Introductionmentioning

confidence: 92%

Relationship Between Glycemic Control and Gastric Emptying in Poorly Controlled Type 2 Diabetes

Bharucha

Kudva

Basu

et al. 2015

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Background & Aims Acute hyperglycemia delays gastric emptying in patients with diabetes. However, it is not clear whether improved control of glycemia affects gastric emptying in these patients. We investigated whether overnight and short-term (6 months) improvements in control of glycemia affect gastric emptying. Methods We studied 30 patients with poorly controlled type 2 diabetes (levels of glycated hemoglobin >9%). We measured gastric emptying using the [13C]-spirulina platensis breath test on the patients’ first visit (visit 1), after overnight administration of insulin or saline, 1 week later (visit 2), and 6 months after intensive therapy for diabetes. We also measured fasting and post-prandial plasma levels of C-peptide, GLP1, and amylin, as well as autonomic functions. Results At visit 1, gastric emptying was normal in 10 patients, delayed in 14, and accelerated in 6; 6 patients had gastrointestinal symptoms; vagal dysfunction was associated with delayed gastric emptying (P<.05). Higher fasting blood levels of glucose were associated with shorter half-times of gastric emptying (thalf) at visits 1 (r= −0.46, P=.01) and 2 (r= −0.43, P=.02). Although blood levels of glucose were lower after administration of insulin (132±7 mg/dl) than saline (211±15 mg/dl; P=0.0002), gastric emptying thalf was not lower after administration of insulin, compared with saline. After 6 months of intensive therapy, levels of glycated hemoglobin decreased from 10.6%±0.3% to 9%±0.4% (P=.0003), but gastric emptying thalf did not change (92±8 min before, 92±7 min after). Gastric emptying did not correlate with plasma levels of GLP1 and amylin. Conclusions Two-thirds of patients with poorly-controlled type 2 diabetes have mostly asymptomatic yet abnormal gastric emptying. Higher fasting blood levels of glucose are associated with faster gastric emptying. Overnight and sustained (6 months) improvements in glycemic control do not affect gastric emptying.

show abstract

“…We have reported stability of gastric emptying over two decades in an unselected group of patients with predominantly T1DM. 35 Longitudinal evaluation of large cohorts of patients with diabetes mellitus who also have gastroparesis revealed no association between gastro paresis and increased poor prognosis; 36,37 although this lack of association might not apply to patients with severely delayed gastric emptying. Contrary to our data, another research group reported decreased overall survival in patients with gastroparesis compared with age-matched and sex-matched control individuals in a communitybased study.…”

Section: Natural Historymentioning

confidence: 98%

“…28,29 By contrast, the intra individual variation of gastric emptying is modest. 35,61 Among patients with T1DM, those with gastroparesis have a reduction in early postprandial insulin requirement compared with those with a normal rate of gastric emptying, 62 whereas in intervention studies in patients with T2DM inhibition of gastric emptying by opiates resulted in a marked decrease in glycaemic excursions. 63 However, following administration of the prokinetic erythromycin to patients with T2DM the opposite effects were observed.…”

Section: Gastric Emptying and Glycaemiamentioning

confidence: 98%

Gastric emptying and glycaemia in health and diabetes mellitus

et al. 2014

Self Cite

View full text Add to dashboard Cite

The rate of gastric emptying is a critical determinant of postprandial glycaemia and, accordingly, is fundamental to maintaining blood glucose homeostasis. Disordered gastric emptying occurs frequently in patients with longstanding type 1 diabetes mellitus and type 2 diabetes mellitus (T2DM). A complex bidirectional relationship exists between gastric emptying and glycaemia--gastric emptying accounts for ∼35% of the variance in peak postprandial blood glucose concentrations in healthy individuals and in patients with diabetes mellitus, and the rate of emptying is itself modulated by acute changes in glycaemia. Clinical implementation of incretin-based therapies for the management of T2DM, which diminish postprandial glycaemia, in part by slowing gastric emptying, is widespread. Other therapies for patients with T2DM, which specifically target gastric emptying include pramlintide and dietary-based treatment approaches. A weak association exists between upper gastrointestinal symptoms and the rate of gastric emptying. In patients with severe diabetic gastroparesis, pathological changes are highly variable and are characterized by loss of interstitial cells of Cajal and an immune infiltrate. Management options for patients with symptomatic gastroparesis remain limited in their efficacy, which probably reflects the heterogeneous nature of the underlying pathophysiology.

show abstract

A 25-Year Longitudinal Evaluation of Gastric Emptying in Diabetes

Cited by 52 publications

References 10 publications

Epidemiology and Natural History of Gastroparesis

Epidemiology and Natural History of Gastroparesis

Relationship Between Glycemic Control and Gastric Emptying in Poorly Controlled Type 2 Diabetes

Gastric emptying and glycaemia in health and diabetes mellitus

Contact Info

Product

Resources

About