Diabetic gastroparesis—Backwards and forwards

Chang, Jessica; Rayner, Christopher K.; Jones, Karen L.; Horowitz, Michael

doi:10.1111/j.1440-1746.2010.06573.x

Cited by 36 publications

(30 citation statements)

References 116 publications

(143 reference statements)

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“…Cross-sectional studies have reported there to be a 30-50% prevalence of gastroparesis in longstanding type 1 or 2 diabetes [15,39], although GE may be accelerated [16], perhaps particularly in 'early' type 2 diabetes [39]. Our patients had type 2 diabetes of relatively short duration, good glycaemic control and no microvascular complications.…”

Section: Discussionmentioning

confidence: 99%

“…GE in healthy individuals exhibits a wide interindividual variation of~4-17 kJ/min (~1-4 kcal/min) [14]; this is increased in diabetes because of the high prevalence of delayed [15], and occasionally rapid, GE [16]. The reduction in postprandial glucose following acute administration of GLP-1 [17][18][19] or 'short-acting' GLP-1 agonists [20,21] relates primarily to slowing of GE but clinical studies relating to the effects of GLP-1 and its agonists on BP have not discriminated between effects on fasting vs postprandial BP.…”

Section: Introductionmentioning

confidence: 99%

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Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes

et al. 2015

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Aims/hypothesis A postprandial fall in BP occurs frequently in older individuals and in patients with type 2 diabetes. The magnitude of this decrease in BP is related to the rate of gastric emptying (GE). Intravenous administration of glucagon-like peptide-1 (GLP-1) attenuates the hypotensive response to intraduodenal glucose in healthy older individuals. We sought to determine the effects of exogenous GLP-1 on BP, GE, superior mesenteric artery (SMA) flow and glycaemic response to oral ingestion of glucose in healthy older individuals and patients with type 2 diabetes. Methods Fourteen older volunteers (six men, eight women; age 72.1±1.1 years) and ten patients with type 2 diabetes (six men, four women; age 68.7±3.4 years; HbA 1c 6.6±0.2% [48.5± 2.0 mmol/mol]; nine with blood glucose managed with metformin, two with a sulfonylurea and one with a dipeptidyl-peptidase 4 inhibitor) received an i.v. infusion of GLP-1 (0.9 pmol kg −1 min −1 ) or saline (154 mmol/l NaCl) for 150 min (t=−30 min to t= 120 min) in randomised order. At t=0 min, volunteers consumed a radiolabelled 75 g glucose drink. BP was assessed with an automated device, GE by scintigraphy and SMA flow by ultrasonography. Blood glucose and serum insulin were measured. Results GLP-1 attenuated the fall in diastolic BP after the glucose drink in older individuals (p<0.05) and attenuated the fall in systolic and diastolic BP in patients with type 2 diabetes (p<0.05). GE was faster in patients with type 2 diabetes than in healthy individuals (p<0.05). In both groups, individuals had slower GE (p<0.001), decreased SMA flow (p<0.05) and a lower degree of glycaemia (p<0.001) when receiving GLP-1. Conclusions/interpretation Intravenous GLP-1 attenuates the hypotensive response to orally administered glucose and decreases SMA flow, probably by slowing GE. GLP-1 and 'short-acting' GLP-1 agonists may be useful in the management of postprandial hypotension.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes

et al. 2015

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“…Acute hyperglycaemia slows gastric emptying in people with diabetes mellitus and healthy controls. [12][13][14] The gastric antral motility is reduced when blood glucose levels increase to more than 9 mmol/L and reaches a standstill when blood glucose levels increase to more than 15 mmol/L (reference range [12][13][14]. Hyperglycaemia also reduces the efficacy of prokinetic drugs.…”

Section: Discussionmentioning

confidence: 99%

Intractable nausea and vomiting associated with poor glycaemic control in a patient with type 1 diabetes

Setty

Kong

2016

BMJ

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“…Gastroparesis, a kind of GI complication of DM, is characterized by delayed gastric emptying[10], and occurs as a result of a problem in postprandial gastric contraction activity[9,11,12]. The major symptoms of gastroparesis include postprandial fullness, early satiety, nausea, vomiting, abdominal distension, and abdominal pain.…”

Section: Introductionmentioning

confidence: 99%

Characterization of smooth muscle, enteric nerve, interstitial cells of Cajal, and fibroblast-like cells in the gastric musculature of patients with diabetes mellitus

Park

Cho

Hwang

et al. 2016

WJG

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AIMTo investigate histologic abnormalities in the gastric smooth muscle of patients with diabetes mellitus (DM).METHODSFull-thickness gastric specimens were obtained from patients undergoing surgery for gastric cancer. H&E stain and Masson’s Trichrome stain were performed to assess the degree of fibrosis. Immunohistochemical staining using various antibodies was also performed [antibodies against protein gene product 9.5 (PGP9.5), neuronal nitric oxide synthase (nNOS), vasoactive intestinal peptide (VIP), neurokinin-1 (NK1) receptor, c-Kit, and platelet-derived growth factor receptor-alpha, (PDGFRα)]. Immunofluorescent staining and evaluation with confocal microscopy were also conducted.RESULTSTwenty-six controls and 35 diabetic patients (21 short-duration patients and 14 long-duration patients) were included. There were no significant differences in basic demographics between the two groups except in mean body mass index (BMI) (higher in the DM group). Proportions of moderate-to-severe intercellular fibrosis in the muscle layer were significantly higher in the DM group than in the control group (P < 0.01). On immunohistochemical staining, c-Kit- and PDGFRα-positive immunoreactivity were significantly decreased in the DM group compared with the control group (P < 0.05). There were no statistically significant differences in PGP9.5, nNOS, VIP, and neurokinin 1 expression. On immunofluorescent staining, cellularity of interstitial cells of Cajal (ICC) was observed to decrease with increasing duration of DM.CONCLUSIONOur study suggests that increased intercellular fibrosis, loss of ICC, and loss of fibroblast-like cells are found in the smooth muscle of DM patients. These abnormalities may contribute to changes in gastric motor activity in patients with DM.

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Diabetic gastroparesis—Backwards and forwards

Cited by 36 publications

References 116 publications

Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes

Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes

Intractable nausea and vomiting associated with poor glycaemic control in a patient with type 1 diabetes

Characterization of smooth muscle, enteric nerve, interstitial cells of Cajal, and fibroblast-like cells in the gastric musculature of patients with diabetes mellitus

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