Diabetic gastroparesis

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

doi:10.1016/b978-0-12-818586-5.00018-1

Cited by 2 publications

(8 citation statements)

References 139 publications

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“…While there are abnormalities in vagal innervation, contrary to expectation, the relationship of delayed gastric emptying with autonomic dysfunction, as assessed by cardiovascular reflex tests, is weak [1,2]. Loss or damage to the ICCs appears to be a dominant abnormality [3,6,11], where altered immune function with a shift from M2 to M1 macrophage expression and impaired regulation of haem oxygenase 1 leading to increased oxidative stress may be responsible [6,11]. Other common abnormalities include reductions in intrinsic nerves and inhibitory neurons expressing nitric oxide synthase (NOS) [3,6].…”

Section: Pathophysiology Of Diabetic Gastroparesismentioning

confidence: 83%

“…Loss or damage to the ICCs appears to be a dominant abnormality [3,6,11], where altered immune function with a shift from M2 to M1 macrophage expression and impaired regulation of haem oxygenase 1 leading to increased oxidative stress may be responsible [6,11]. Other common abnormalities include reductions in intrinsic nerves and inhibitory neurons expressing nitric oxide synthase (NOS) [3,6]. Not surprisingly, gastroduodenal motor and sensory dysfunctions in gastroparesis are also highly variable; frequent abnormalities include impaired relaxation of the proximal stomach, reduced antral contractility and abnormalities of the gastric electrical rhythm [3,6].…”

Section: Pathophysiology Of Diabetic Gastroparesismentioning

confidence: 99%

“…Other common abnormalities include reductions in intrinsic nerves and inhibitory neurons expressing nitric oxide synthase (NOS) [3,6]. Not surprisingly, gastroduodenal motor and sensory dysfunctions in gastroparesis are also highly variable; frequent abnormalities include impaired relaxation of the proximal stomach, reduced antral contractility and abnormalities of the gastric electrical rhythm [3,6].…”

Section: Pathophysiology Of Diabetic Gastroparesismentioning

confidence: 99%

“…Similar considerations apply to the widespread assessment of gastrointestinal symptoms using participant self-report, which is known to be unreliable, rather than validated questionnaires, which are now mandated by regulatory authorities in studies of drug therapy for functional gastrointestinal diseases [19]. Evaluation of gastric emptying using the wireless motility capsule is a newer technique; however, the indigestible capsule tends to be emptied later than nutrient liquids and solids, and it may be insensitive for detecting abnormally rapid gastric emptying [3,6]. Other newer techniques for measuring gastric emptying, including MRI and three-dimensional ultrasound, remain primarily in the research domain [3,6].…”

Section: Evaluation Of Gastric Emptyingmentioning

confidence: 99%

“…Gastroparesis is defined by abnormally delayed gastric emptying in the absence of mechanical obstruction. Once thought to be relatively rare, a belief influenced by the outcome of epidemiological studies that defined gastroparesis based on upper gastrointestinal symptoms without measuring gastric emptying, it is now recognised that gastric emptying is abnormally slow in 30-50% of individuals with long-standing, complicated, type 1 or type 2 diabetes [1][2][3]. It is also appreciated that gastroparesis has clinical implications beyond that of symptoms, including malnutrition, glycaemic instability and impaired absorption of orally administered drugs.…”

Section: Introductionmentioning

confidence: 99%

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Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control

et al. 2022

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Gastric emptying is a major determinant of postprandial blood glucose, accounting for ~35% of variance in peak glucose in both healthy individuals and those with type 2 diabetes. Gastric emptying is frequently disordered in individuals with diabetes (both abnormally delayed and accelerated). Delayed gastric emptying, i.e. diabetic gastroparesis, may be linked to upper gastrointestinal symptoms for which current treatment remains suboptimal; pharmacological acceleration of delayed emptying is only weakly associated with symptom improvement. Accordingly, the relationship between symptoms and delayed gastric emptying is not simply ‘cause and effect’. In insulin-treated patients, disordered gastric emptying, even when not associated with gastrointestinal symptoms, can cause a mismatch between the onset of insulin action and the availability of absorbed carbohydrate, leading to suboptimal glycaemic control. In patients with type 2 diabetes, interventions that slow gastric emptying, e.g. glucagon-like peptide-1 receptor agonists, reduce postprandial blood glucose. This review focuses on recent insights into the impact of gastric emptying on postprandial blood glucose, effects of diabetes therapy on gastric emptying and the management of disordered gastric emptying in diabetes. In view of the broad relevance of gastric emptying to diabetes management, it is important that future clinical trials evaluating novel therapies that may affect gastric emptying should quantify the latter with an appropriate technique, such as scintigraphy or a stable isotope breath test. Graphical abstract

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Section: Pathophysiology Of Diabetic Gastroparesismentioning

confidence: 83%

Section: Pathophysiology Of Diabetic Gastroparesismentioning

confidence: 99%

Section: Pathophysiology Of Diabetic Gastroparesismentioning

confidence: 99%

Section: Evaluation Of Gastric Emptyingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control

et al. 2022

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Manipulation of Post-Prandial Hyperglycaemia in Type 2 Diabetes: An Update for Practitioners

Shibib,

Al-Qaisi,

Guess

et al. 2024

DMSO

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This review paper explores post-prandial glycemia in type 2 diabetes. Post-prandial glycemia is defined as the period of blood glucose excursion from immediately after the ingestion of food or drink to 4 to 6 hours after the end of the meal. Post-prandial hyperglycemia is an independent risk factor for cardiovascular disease with glucose “excursions” being more strongly associated with markers of oxidative stress than the fasting or pre-prandial glucose level. High blood glucose is a major promoter of enhanced free radical production and is associated with the onset and progression of type 2 diabetes. Oxidative stress impairs insulin action creating a vicious cycle where repeated post-prandial glucose spikes are key drivers in the pathogenesis of the vascular complications of type 2 diabetes, both microvascular and macrovascular. Some authors suggest post-prandial hyperglycemia is the major cause of death in type 2 diabetes. Proper management of post-prandial hyperglycemia could yield up to a 35% cut in overall cardiovascular events, and a 64% cut in myocardial infarction. The benefits of managing post-prandial hyperglycemia are similar in magnitude to those seen in type 2 diabetes patients receiving secondary prevention with statins – prevention which today is regarded as fundamental by all practitioners. Given all the evidence surrounding the impact of post-prandial glycemia on overall outcome, it is imperative that any considered strategy for the management of type 2 diabetes should include optimum dietary, pharma, and lifestyle interventions that address glucose excursion. Achieving a low post-prandial glucose response is key to prevention and progression of type 2 diabetes and cardiometabolic diseases. Further, such therapeutic interventions should be sustainable and must benefit patients in the short and long term with the minimum of intrusion and side effects. This paper reviews the current literature around dietary manipulation of post-prandial hyperglycemia, including novel approaches. A great deal of further work is required to optimize and standardize the dietary management of post-prandial glycemia in type 2 diabetes, including consideration of novel approaches that show great promise.

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Diabetic gastroparesis

Cited by 2 publications

References 139 publications

Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control

Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control

Manipulation of Post-Prandial Hyperglycaemia in Type 2 Diabetes: An Update for Practitioners

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