Gastric emptying in diabetic autonomic neuropathy.

Campbell, Ian W; Heading, R. C.; Tothill, P.; Buist, T. A. S.; Ewing, D J; Clarke, B F

doi:10.1136/gut.18.6.462

Cited by 142 publications

(69 citation statements)

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“…An impaired gastric emptying pattern of solids and a disturbed ability of the stomach to distinguish solids from liquids have been observed in diabetic patients as compared to healthy controls [22,23], while other investigations report no such findings in diabetic patients [241. A different mechanism of action in the digestion process and an altered control of the gastric emptying may explain the proportionally lower difference between the glycaemic responses in well-controlled diabetic patients following ingestion of test meals with varying water contents, as compared to younger, healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

Effect on the postprandial glycaemic level of the addition of water to a meal ingested by healthy subjects and Type 2 (non-insulin-dependent) diabetic patients

Torsdottir

Andersson

1989

Diabetologia

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Summary. The effects on postprandial glycaemic reactions of adding a glass of water to a meal were studied in 7 healthy male subjects and 20 Type 2 (non-insulin-dependent) diabetic patients for a period of up to 3 h. The subjects were served a meal of potatoes and meat, with or without 300 ml of water, in random order on two mornings after a 12-h fast. The diabetic patients were considered as well-controlled or not well-controlled according to HbAlc and blood glucose fasting values. Water addition increased the peak blood glucose (p < 0.02) and serum insulin (p < 0.02) levels in healthy subjects, and the blood glucose concentration in well-controlled diabetic patients (p < 0.02). The addition of water also increased the overall blood glucose response, calculated as the positive incremental area, in healthy subjects by 68 + 25% (p < 0.02) and in well-controlled diabetic patients by 40 + 14% (p < 0.01). In poorly-controlled diabetic patients, however, the addition of water did not display significant effects, probably due to the varying fasting glycaemia in these patients. Thus, altering the physical property of a meal by dilution with water can affect the physiological responses; the results are considered to be relevant for the on-going discussion concerning the use of physiological responses to foods as a basis for diet instructions to diabetic patients.Key words: Type2 (non-insulin-dependent) diabetes, postprandial glycaemia, water ingestion, glycaemic index.Physiological responses to carbohydrate foods have been suggested as a basis for instructions to diabetic patients [1, 2] preferable to the traditional exchange system built on quantity and molecular weight of the carbohydrate content [3]. This is a conclusion from studies which have shown varying postprandial blood glucose responses after the ingestion of comparable and isocaloric food items. The blood glucose rise following the consumption of potatoes is higher than after the consumption of most other starchy foods [1,4,5]. Moreover, the plasma glucose response in healthy subjects is 40-60% lower when a monosaccharide or starch is served as a solid meal, than when the same carbohydrate is given as a liquid [6]. The physical property of starchy foods has also been shown to affect blood glucose and hormonal levels following meals [7,8].The identification of meal characteristics that attenuate the glycaemic response is far from complete. In many countries, it is common to drink during a meal, but knowledge of the effects of adding liquids to meals on the postprandial response is limited. It has been reported in abstracts that adding water to meals can increase the glycaemic response in healthy subjects [9,10]. The effect of drinking during meals on the glycaemic response in diabetic patients is, however, virtually unknown. The rate of gastric emptying affects the absorption rate of meal components and is related to the postprandial blood glucose level after meals [5,11,12]. Solid foods of meat, labelled by radioactive isotopes to measure gastric emptying, h...

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Section: Discussionmentioning

confidence: 99%

Effect on the postprandial glycaemic level of the addition of water to a meal ingested by healthy subjects and Type 2 (non-insulin-dependent) diabetic patients

Torsdottir

Andersson

1989

Diabetologia

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“…It has been commented that atony, distention and gastric emptying are generally asymptomatic because of a possible denervation of afferent sensory fibers 20 . Other authors argue that when the symptoms are present they include anorexia, nausea, vomiting and persistent fullness 1,5 .…”

Section: Discussionmentioning

confidence: 99%

“…Neuron incidence found in control and diabetic group animals in a 11.6 mm 2 area in the small and large curvature. Given that the neurons of the myenteric plexus, among other functions, control gastric motility and the muscular tonus of the stomach, we may assume that their decreased density in diabetic animals is one of the major causes of the abnormal gastric motility, distention and gastric atony observed in diabetic hamsters 6 and of the gastric stasis observed in humans 5 . Radiological evidence of gastric retention has been reported for diabetic humans and was found to be related to diabetic autonomic neuropathy 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies on streptozotocininduced diabetic rats have emphasized the alterations that occur in the small and large intestines. However, it should be remembered that alterations in the neurons of the myenteric plexus, in addition to changing intestinal peristalsis, can affect stomach motility, leading to dilation and retarded gastric emptying, interfering with the coordination between stomach and duodenum and impairing the digestive process 5 .…”

mentioning

confidence: 99%

“…In humans, among the clinical manifestations of autonomic neuropathy, there is motor impairment of the stomach, which can lead to anorexia, nausea, vomiting and persisting fullness, characterizing gastric debilitation 1,5 . It is also noteworthy that diabetic gastric atony is similar to that observed after vagotomy 5 .…”

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confidence: 99%

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Quantitative study of the myenteric plexus of the stomach of rats with streptozotocin-induced diabetes

Fregonesi

Miranda-Neto

Molinari

et al. 2001

Arq. Neuro-Psiquiatr.

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-The purpose of the present study was to investigate the morphological and quantitative alterations of the myenteric plexus neurons of the stomach of rats with streptozotocin-induced chronic diabetes and compare them to those of non-diabetic animals. Samples from the body of the stomach were used for wholemount preparations stained with NADH-diaphorase and for histological sections stained with hematoxylineosin. It was observed that diabetes cause a significant decrease on the number of neurons.KEY WORDS: myenteric plexus, diabetes, rat.Estudo quantitativo do plexo mientérico do estômago de ratos com diabetes induzido por estreptozootocina RESUMO -A proposta deste trabalho foi estudar as alterações morfológicas e quantitativas dos neurônios do plexo mientérico do estômago de ratos com diabetes induzido por estreptozootocina e estabelecer uma comparação com animais não diabéticos. Amostras do corpo do estômago foram submetidas a preparados de membrana corados pelo método da NADH-diaforase e a cortes histológicos corados por hematoxilinaeosina. Observou-se que o diabetes provoca significante redução no número de neurônios. Diabetes mellitus is a pathological condition in which several physiological abnormalities are observed, such as neuropathies that affect the central nervous system, the peripheral nerves and the autonomic nervous system 1 . Streptozotocin-induced diabetes causes a cycle of events in the nerve cells of the myenteric plexus that begins within one to three days, with the development of chromatolysis followed by regenerative changes over the next six weeks, with some continuous, albeit occasional, ganglionic degeneration 2 ; changes in the innervation of the ileum and colon 3 are reported, as well as a decrease on the neuronal activity 4 . Studies on streptozotocininduced diabetic rats have emphasized the alterations that occur in the small and large intestines. However, it should be remembered that alterations in the neurons of the myenteric plexus, in addition to changing intestinal peristalsis, can affect stomach motility, leading to dilation and retarded gastric emptying, interfering with the coordination between stomach and duodenum and impairing the digestive process 5 . PALAVRAS-CHAVEIn a diabetic ketonuric Chinese hamsters examination of the gastrointestinal tract was observed that the animals had distention and atony of the stomach and intestines when compared with control animals 6 . In humans, among the clinical manifestations of autonomic neuropathy, there is motor impairment of the stomach, which can lead to anorexia, nausea, vomiting and persisting fullness, characterizing gastric debilitation 1,5 . It is also noteworthy that diabetic gastric atony is similar to that observed after vagotomy 5 .Considering the extensive development of the myenteric plexus and its importance for the control of gastric and intestinal functions, and suspecting that diabetes may affect these neurons, in this way contributing to the gastric disturbances, we undertook the present study to determine ...

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Gastrointestinal Tract Complications of Diabetes Mellitus

Yang¹

1984

Arch Intern Med

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Gastric emptying in diabetic autonomic neuropathy.

Cited by 142 publications

References 32 publications

Effect on the postprandial glycaemic level of the addition of water to a meal ingested by healthy subjects and Type 2 (non-insulin-dependent) diabetic patients

Effect on the postprandial glycaemic level of the addition of water to a meal ingested by healthy subjects and Type 2 (non-insulin-dependent) diabetic patients

Quantitative study of the myenteric plexus of the stomach of rats with streptozotocin-induced diabetes

Gastrointestinal Tract Complications of Diabetes Mellitus

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