TY - JOUR
T1 - Relationship between glycemic control and gastric emptying in poorly controlled type 2 diabetes
AU - Bharucha, Adil E.
AU - Kudva, Yogish
AU - Basu, Ananda
AU - Camilleri, Michael
AU - Low, Phillip A.
AU - Vella, Adrian
AU - Zinsmeister, Alan R.
N1 - Funding Information:
Funding Supported primarily by the United States Public Health Service National Institutes of Health grant R01 DK068055 . This study was made possible by a Center for Clinical and Translational Science (CCaTS) grant (UL1 TR000135) from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. Also supported in part by National Institutes of Health grants NS 32352, NS 44233, and U54 NS065736, and Mayo funds (P.A.L.). The contents are solely the responsibility of the author(s) and do not necessarily represent the official view of National Center for Research Resources or the National Institutes of Health.
Publisher Copyright:
© 2015 AGA Institute.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - 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 mo) improvements in control of glycemia affect gastric emptying. Methods: We studied 30 patients with poorly controlled type 2 diabetes (level of glycosylated 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 postprandial plasma levels of C-peptide, glucagon-like peptide 1, 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; 6patients 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= .0002), gastric emptying thalf was not lower after administration of insulin, compared with saline. After 6 months of intensive therapy, levels of glycosylated 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 glucagon-like peptide 1 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 mo) improvements in glycemic control do not affect gastric emptying.
AB - 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 mo) improvements in control of glycemia affect gastric emptying. Methods: We studied 30 patients with poorly controlled type 2 diabetes (level of glycosylated 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 postprandial plasma levels of C-peptide, glucagon-like peptide 1, 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; 6patients 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= .0002), gastric emptying thalf was not lower after administration of insulin, compared with saline. After 6 months of intensive therapy, levels of glycosylated 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 glucagon-like peptide 1 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 mo) improvements in glycemic control do not affect gastric emptying.
KW - Autonomic
KW - DM
KW - Diabetes mellitus
KW - Gastroparesis
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U2 - 10.1016/j.cgh.2014.06.034
DO - 10.1016/j.cgh.2014.06.034
M3 - Article
C2 - 25041866
AN - SCOPUS:84925294039
SN - 1542-3565
VL - 13
SP - 466-476.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -