Gastric emptying and glycaemia in health and diabetes mellitus

Abstract

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.

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

“…Interestingly, none of the demographic characteristics was found to be significantly associated with delayed gastric emptying in the present cohort. Although diabetes is a recognized risk factor for gastroparesis, this is restricted mainly to patients with poorly controlled insulin‐dependent diabetes10. In the present study, only one of 15 patients with diabetes was insulin‐dependent, and most had adequate glycaemic control.…”

“…There is no consensus definition across these tests10. Nuclear scintigraphy has been the test used most commonly11, although a recent study12 suggested that endoscopic evidence of food retention following routine fasting closely correlates with severe delayed gastric emptying on nuclear scintigraphy.…”

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

“…Intuitively, once-or twice-daily administration of 'short-acting' preparations of GLP-1 agonists, such as exenatide and lixisenatide, which predominantly diminish postprandial glucose by slowing GE [45,46], may have greater efficacy than once-weekly administration of longer-acting drugs, such as liraglutide and modified-release exenatide, where the slowing of GE appears to be modest with chronic use [45,46]. In summary, in healthy older individuals and patients with type 2 diabetes, acute i.v.…”

Effect of rice cooking methods on postprandial glycaemic response, satiety and palatability, and chewed particle size distribution

“…Another theory is that more thorough mastication (i.e. longer chewing time) and swallowing a food bolus with fine particles (< 2,000 μm) may delay gastric emptying and thus reduce postprandial glycaemia [6,30,32]. A bolus with finer particles reduces the viscosity of gastric content and increases pyloric outflow, thus increases sedimentation of solids in liquids and promotes the ability of antrum to preferentially empty liquids faster than solids [29].…”