Relationship between glycemic control and gastric emptying in poorly controlled type 2 diabetes

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)466-476
Number of pages11
JournalClinical Gastroenterology and Hepatology
Volume13
Issue number3
DOIs
StatePublished - Mar 1 2015

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Gastric Emptying
Type 2 Diabetes Mellitus
Islet Amyloid Polypeptide
Blood Glucose
Fasting
Glucagon-Like Peptide 1
Glycosylated Hemoglobin A
Insulin
Spirulina
Breath Tests
C-Peptide
Hyperglycemia

Keywords

  • Autonomic
  • Diabetes mellitus
  • DM
  • Gastroparesis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

@article{3b62b762df634e12973e4e46f009d238,
title = "Relationship between glycemic control and gastric emptying in poorly controlled type 2 diabetes",
abstract = "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.",
keywords = "Autonomic, Diabetes mellitus, DM, Gastroparesis",
author = "Bharucha, {Adil Eddie} and Kudva, {Yogish C} and Ananda Basu and Michael Camilleri and Low, {Phillip Anson} and Adrian Vella and Zinsmeister, {Alan R.}",
year = "2015",
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doi = "10.1016/j.cgh.2014.06.034",
language = "English (US)",
volume = "13",
pages = "466--476",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
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T1 - Relationship between glycemic control and gastric emptying in poorly controlled type 2 diabetes

AU - Bharucha, Adil Eddie

AU - Kudva, Yogish C

AU - Basu, Ananda

AU - Camilleri, Michael

AU - Low, Phillip Anson

AU - Vella, Adrian

AU - Zinsmeister, Alan R.

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 - Diabetes mellitus

KW - DM

KW - Gastroparesis

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