Gastric emptying in non-insulin dependent diabetes mellitus - relationship to oral glucose tolerance

Jones, Kimberly L.; Horowitz, Michael; Carney, B. I.; Wishart, J.; Green, L.; Guha, Shaibal; Harding, P.

doi:10.1016/0016-5085(95)26804-9

Cited by 13 publications

(22 citation statements)

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“…The control group was younger than the diabetic group, but since ageing is associated with slower gastric emptying, 18 it is unlikely that this age difference is responsible for our results. The accelerated rate of emptying of liquids in asymptomatic Type 2 diabetic patients agrees with previous reports 5,6,9,19 but is at variance with Jones et al 20 Phillips et al documented rapid gastric emptying of a liquid meal in asymptomatic patients with recently diagnosed Type 2 diabetes 6 and claimed that a predisposition to rapid gastric emptying may play an important role in the pathogenesis of Type 2 diabetes. 6,19 Our patients had all had known diabetes for at least 5 years, which demonstrates that rapid emptying is not limited to the early years of disease.…”

Section: Discussionsupporting

confidence: 90%

Rapid gastric emptying of a liquid meal in long-term Type 2 diabetes mellitus

et al. 1998

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Both delayed and accelerated gastric emptying rate (GER) have been reported in patients with diabetes mellitus. Delayed GER has been attributed to autonomic neuropathy in established diabetes but rapid GER was demonstrated in early Type 2 diabetes. The aim of the study was to investigate rapid gastric emptying in a group of people with long-duration Type 2 diabetes. GER of a radiolabelled liquid meal was studied scintigraphically in 20 Type 2 patients with a mean (+/-SEM) duration of diabetes 13 (+/-1) years. The 50% emptying time (t50) for the liquid meal was shorter in diabetic patients (29.6+/-2.1 min) than in controls (39.2+/-1.9 min; p<0.0005). Accelerated emptying (t50 value below the shortest t50 of controls) was evidenced in 14/20 patients and delayed emptying (t50 value exceeding the upper t50 of controls) in none. Patients with accelerated GER were comparable for BMI, diabetes duration, HbA1c and fasting glycaemia to those with normal GER. Rapid GER for liquids was found in the presence or absence of autonomic neuropathy. Seven of the patients with rapid emptying of the liquid meal were reassessed using a solid meal. Only one patient demonstrated rapid emptying of the solid meal, which was normal in 3 and delayed in 3 patients. In conclusion, accelerated GER can be found in long-term Type 2 diabetes but there is no concordance between GER of a liquid and a solid meal.

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Section: Discussionsupporting

confidence: 90%

Rapid gastric emptying of a liquid meal in long-term Type 2 diabetes mellitus

et al. 1998

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“…Changes in gastric emptying and transpyloric flow induced by posture may also potentially affect glucose absorption and postprandial blood glucose concentrations. It is known that the rate of gastric emptying accounts for approximately 35% of the variance in postprandial blood glucose concentrations in healthy subjects and patients with type 2 diabetes mellitus [17,18]; the initial rate of gastric emptying appears to be predominantly important in the glycemic response to oral carbohydrate [19,20]. Despite this, there is a lack of standardization in both the volume of glucose drink and the subject posture in oral glucose tolerance tests [21].…”

Section: Abstract Gastric Emptying Transpyloric Flow Posturementioning

confidence: 99%

Effects of Posture on Gastric Emptying, Transpyloric Flow, and Hunger After a Glucose Drink in Healthy Humans

et al. 2006

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Previous studies suggest that posture has relatively little effect on gastric emptying of high-nutrient liquids; these studies have, however, only assessed overall rates of gastric emptying, whereas gastric emptying is known to be predominantly a pulsatile phenomenon. In healthy subjects perceptions of appetite, such as hunger, are inversely related to antral area and content; hence, changes in intragastric meal distribution induced by posture may affect appetite. Gastric emptying is a major determinant of postprandial glycemia. The aims of this study were to evaluate the effects of posture on patterns of transpyloric flow (TF), gastric emptying (GE), antral area (AA), hunger, and the glycemic response to oral glucose. Eight healthy young subjects (five males, three females; mean age, 24.0 +/- 2.4 years; BMI, 21.2 +/- 0.6 kg/m2) were studied twice in random order, once in the sitting position and once in the lying (supine) position. After consuming 600 ml water with 75 g glucose, labeled with 20 MBq 99mTc-sulfur colloid, subjects had simultaneous measurements of (i) TF during consumption of the drink by Doppler ultrasonography, (ii) GE with scintigraphy, (iii) AA at t = -5 and t = 30 min by ultrasonography, and (iv) perceptions of appetite with a visual analogue scale. During drink ingestion TF was greater in the sitting, compared with the lying, position (586 +/- 170 vs. 177 +/- 65 [cm/sec] x sec; P < 0.05). Posture affected intragastric distribution; more of the drink was retained in the distal stomach in the sitting position (e.g., at 30 min: sitting, 29 +/- 3%, vs. lying, 12 +/- 3%; P < 0.0001) but had no effect on the overall rate of GE or the blood glucose response. AA at t = 30 min (P < 0.005) was greater in the sitting position; there was an inverse relationship between hunger and AA at 30 min (r = -0.53, P < 0.05). We conclude that posture influences initial TF and intragastric distribution, but not the overall rate of GE of, or the glycemic response to, a large-volume nutrient liquid. The increases in AA and content in the sitting position are associated with a reduction in hunger.

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“…Gastric emptying is recognized as a major determinant of postprandial glycemia in both healthy subjects (8) and patients with type 2 diabetes (15,28). It has been suggested that a lack of standardization of the volume of water ingested in an oral glucose tolerance test accounts for some of its documented variability (4,6,(32)(33)(34).…”

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Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects

Jones

O’Donovan

Russo

et al. 2005

American Journal of Physiology-Gastrointestinal and Liver Physi

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. Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects. Am J Physiol Gastrointest Liver Physiol 289: G240 -G248, 2005. First published March 17, 2005 doi:10.1152/ajpgi.00030.2005.-Postprandial hypotension (PPH) occurs frequently in the elderly; the magnitude of the fall in blood pressure (BP) is related to the rate of glucose entry into the duodenum during intraduodenal glucose infusion and spontaneous gastric emptying (GE). It is unclear if glucose concentration affects the hypotensive response. Gastric distension may attenuate PPH; therefore, meal volume could influence the BP response. We aimed to determine the effects of 1) drink volume, 2) glucose concentration, and 3) glucose content on the BP and heart rate (HR) responses to oral glucose. Ten subjects (73.9 Ϯ 1.2 yr) had measurements of BP, GE, and blood glucose on 4 days after 1) 25 g glucose in 200 ml (12.5%), 2) 75 g glucose in 200 ml (37.5%), 3) 25 g glucose in 600 ml (4%), and 4) 75 g glucose in 600 ml (12.5%). GE, BP, HR, and blood glucose were measured for 180 min. After all drinks, duodenal glucose loads were similar in the first 60 min. Regardless of concentration, 600-ml (but not 200-ml) drinks initially increased BP, and in the first 30 min, systolic BP correlated (P Ͻ 0.01) with volume in both the proximal and total stomach. At the same concentration (12.5%), systolic BP fell more (P ϭ 0.02) at the smaller volume; at the same volumes, there were no effects of concentration on BP. There was no difference in the glycemic response to drinks of identical glucose content. We conclude that 1) ingestion of glucose at a higher volume attenuates and 2) under constant duodenal load, glucose concentration (4 -37%) does not affect the fall in BP. postprandial hypotension; gastric emptying; elderly POSTPRANDIAL HYPOTENSION, leading to syncope and falls, is an important clinical problem, particularly in the elderly and patients with autonomic dysfunction (7,12,14,19). The mechanisms responsible for postprandial hypotension are poorly defined, and current treatments are less than optimal (7,12,14,19). The magnitude of the postprandial fall in blood pressure is known to be dependent on meal compositioningestion of carbohydrate, particularly glucose, has the greatest effect on blood pressure (27), whereas the effects of fat and protein appear to be much less (10).Changes in splanchnic blood flow, sympathetic nerve activity, and release of gastrointestinal peptides are all thought to play a role in postprandial hypotension (7,12,14,19). Onset of the fall in blood pressure is evident soon after a meal, with a maximum response at 30 -60 min (14). While oral ingestion of glucose leads to a fall in blood pressure, intravenous infusion of glucose has little, if any, effect (13) indicating that the response is mediated from the gastrointestinal tract. We have reported that in both healthy older subjects and patients with type 2 diabetes managed by diet alone, the hypotensive and heart rate responses t...

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Gastric emptying in non-insulin dependent diabetes mellitus - relationship to oral glucose tolerance

Cited by 13 publications

References 0 publications

Rapid gastric emptying of a liquid meal in long-term Type 2 diabetes mellitus

Rapid gastric emptying of a liquid meal in long-term Type 2 diabetes mellitus

Effects of Posture on Gastric Emptying, Transpyloric Flow, and Hunger After a Glucose Drink in Healthy Humans

Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects

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