TY - JOUR
T1 - Relationship between gastric emptying and diurnal glycemic control in type 1 diabetes mellitus
T2 - A randomized trial
AU - Parthasarathy, Gopanandan
AU - Kudva, Yogish C.
AU - Low, Phillip A.
AU - Camilleri, Michael
AU - Basu, Ananda
AU - Bharucha, Adil E.
N1 - Publisher Copyright:
© 2017 by the Endocrine Society.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Context: In type 1 diabetes (T1D), delayed gastric emptying (GE) may predispose to a mismatch between insulin delivery and glucose absorption. Previous studies evaluated, only partly, the relationship between delayed GE and postprandial, but not diurnal, glycemia. Objective: To assess the relationship between GE disturbances and glycemic control in T1D and the effects of accelerating GE on glycemic control. Design, Setting, and Participants: This was a randomized placebo-controlled trial in 30 patients with T1D on an insulin pump at an academic medical center. Intervention(s): GE was evaluated with a [13C]-Spirulina breath test at baseline (GEbaseline), during intravenous saline or erythromycin (2 or 3 mg/kg; GEiv), and after 7 days of oral erythromycin or placebo (GEoral). Weighed meals were provided throughout the study. Main Outcome Measure(s): These were GE and continuous glucose monitoring (CGM). Results: The baseline glycosylated hemoglobin was 7.6% ± 0.8% (60 ± 8.7 mmol/mol); 12 patients (40%) had delayed GE; faster GE was associated with a greater postprandial CGM-based glucose, but slower GE was not associated with postprandial hypoglycemia (,70 mg/dL). Intravenous (3 mg/kg) but not oral erythromycin accelerated GE. The relationship between GE and glycemia differed between the postprandial periods and the entire day. After adjusting for carbohydrate intake and insulin consumption, faster GE was associated with more hyperglycemia during the postprandial period but lower glucose values across the entire study. Conclusions: In T1D, pharmacologically mediated acceleration of GE increases postprandial CGM based glucose. In contrast, delayed GE is associated with greater CGM-based glucose values over the entire day.
AB - Context: In type 1 diabetes (T1D), delayed gastric emptying (GE) may predispose to a mismatch between insulin delivery and glucose absorption. Previous studies evaluated, only partly, the relationship between delayed GE and postprandial, but not diurnal, glycemia. Objective: To assess the relationship between GE disturbances and glycemic control in T1D and the effects of accelerating GE on glycemic control. Design, Setting, and Participants: This was a randomized placebo-controlled trial in 30 patients with T1D on an insulin pump at an academic medical center. Intervention(s): GE was evaluated with a [13C]-Spirulina breath test at baseline (GEbaseline), during intravenous saline or erythromycin (2 or 3 mg/kg; GEiv), and after 7 days of oral erythromycin or placebo (GEoral). Weighed meals were provided throughout the study. Main Outcome Measure(s): These were GE and continuous glucose monitoring (CGM). Results: The baseline glycosylated hemoglobin was 7.6% ± 0.8% (60 ± 8.7 mmol/mol); 12 patients (40%) had delayed GE; faster GE was associated with a greater postprandial CGM-based glucose, but slower GE was not associated with postprandial hypoglycemia (,70 mg/dL). Intravenous (3 mg/kg) but not oral erythromycin accelerated GE. The relationship between GE and glycemia differed between the postprandial periods and the entire day. After adjusting for carbohydrate intake and insulin consumption, faster GE was associated with more hyperglycemia during the postprandial period but lower glucose values across the entire study. Conclusions: In T1D, pharmacologically mediated acceleration of GE increases postprandial CGM based glucose. In contrast, delayed GE is associated with greater CGM-based glucose values over the entire day.
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U2 - 10.1210/jc.2016-2809
DO - 10.1210/jc.2016-2809
M3 - Article
C2 - 27880079
AN - SCOPUS:85012042853
SN - 0021-972X
VL - 102
SP - 398
EP - 406
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 2
ER -