Gastrointestinal Transit Disorders in Patients with Insulin-Treated Diabetes mellitus

Wegener, Martin; Börsch, G; Schaffstein, J; Luerweg, C; Leverkus, Friedhelm

doi:10.1159/000171237

Cited by 114 publications

(81 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The American Diabetes Association (2001) has suggested, bearing in mind the varied responses among individuals, that the choice to consume particular types of carbohydrate including polyols must be an individual one, taking account of global dietary guidance and individual metabolic needs. Constipation can be common in diabetics and older individuals (Wegener et al 1990) and older diabetics may indicate that polyol consumption improves bowel habit (Pometta et al 1985). Idiopathic diarrhoea also occurs in diabetics, but is not due to the increased use of polyols, and polyols are not contraindicated in diabetics when consumed in moderate amounts (Verina et al 1995).…”

Section: Tolerancementioning

confidence: 99%

Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties

2003

View full text Add to dashboard Cite

Polyols are hydrogenated carbohydrates used as sugar replacers. Interest now arises because of their multiple potential health benefits. They are non-cariogenic (sugar-free tooth-friendly), lowglycaemic (potentially helpful in diabetes and cardiovascular disease), low-energy and lowinsulinaemic (potentially helpful in obesity), low-digestible (potentially helpful in the colon), osmotic (colon-hydrating, laxative and purifying) carbohydrates. Such potential health benefits are reviewed. A major focus here is the glycaemic index (GI) of polyols as regards the health implications of low-GI foods. The literature on glycaemia and insulinaemia after polyol ingestion was analysed and expressed in the GI and insulinaemic index (II) modes, which yielded the values: erythritol 0, 2; xylitol 13, 11; sorbitol 9, 11; mannitol 0, 0; maltitol 35, 27; isomalt 9, 6; lactitol 6, 4; polyglycitol 39, 23. These values are all much lower than sucrose 65, 43 or glucose 100, 100. GI values on replacing sucrose were independent of both intake (up to 50 g) and the state of carbohydrate metabolism (normal, type 1 with artificial pancreas and type 2 diabetes mellitus). The assignment of foods and polyols to GI bands is considered, these being: high (> 70), intermediate (> 55-70), low (> 40-55), and very low (< 40) including non-glycaemic; the last aims to target particularly low-GI-carbohydrate-based foods. Polyols ranged from low to very low GI. An examination was made of the dietary factors affecting the GI of polyols and foods. Polyol and other food GI values could be used to estimate the GI of food mixtures containing polyols without underestimation. Among foods and polyols a departure of II from GI was observed due to fat elevating II and reducing GI. Fat exerted an additional negative influence on GI, presumed due to reduced rates of gastric emptying. Among the foods examined, the interaction was prominent with snack foods; this potentially damaging insulinaemia could be reduced using polyols. Improved glycated haemoglobin as a marker of glycaemic control was found in a 12-week study of type 2 diabetes mellitus patients consuming polyol, adding to other studies showing improved glucose control on ingestion of low-GI carbohydrate. In general some improvement in long-term glycaemic control was discernible on reducing the glycaemic load via GI by as little as 15-20 g daily. Similar amounts of polyols are normally acceptable. Although polyols are not essential nutrients, they contribute to clinically recognised maintenance of a healthy colonic environment and function. A role for polyols and polyol foods to hydrate the colonic contents and aid laxation is now recognised by physicians. Polyols favour saccharolytic anaerobes and aciduric organisms in the colon, purifying the colon of endotoxic, putrefying and pathological organisms, which has clinical relevance. Polyols also contribute towards short-chain organic acid formation for a healthy colonic epithelium. Polyol toothfriendliness and reduced energy values are affirmed and add to the ...

show abstract

Section: Tolerancementioning

confidence: 99%

Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties

2003

View full text Add to dashboard Cite

show abstract

“…Cross-sectional studies using scintigraphic techniques to measure gastric emptying have shown delayed gastric emptying in patients with diabetes varying from 30 to 60% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, there are several important limitations to these studies.…”

mentioning

confidence: 99%

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Vermeijden²,

et al. 2003

View full text Add to dashboard Cite

OBJECTIVE -Data on the prevalence of abnormal gastric emptying in diabetic patients are still lacking. The relation between gastric emptying and dyspeptic symptoms assessed during gastric emptying measurement has not yet been investigated. The aim was to investigate the prevalence of delayed gastric emptying in a large cohort of unselected diabetic patients and to investigate the relation between gastric emptying and gastrointestinal sensations experienced in the 2 weeks before and during the test meal, prospectively.RESEARCH DESIGN AND METHODS -Gastric emptying was evaluated in 186 patients (106 with type 1 diabetes, mean duration of diabetes 11.6 Ϯ 11.3 years) using 100 mg 13 C-enriched octanoic acid added to a solid meal.RESULTS -Gastric emptying was significantly slower in the diabetic subjects than in the healthy volunteers (T 50 : 99.5 Ϯ 35.4 vs. 76.8 Ϯ 21.4 min, P Ͻ 0.003; Ret 120 min : 30.6 Ϯ 17.2 vs. 20.4 Ϯ 9.7%, P Ͻ 0.006). Delayed gastric emptying was observed in 51 (28%) diabetic subjects. The sensations experienced in the 2 weeks before the test were weakly correlated with the sensation scored during the gastric emptying test. Sensations assessed during the gastric emptying test did predict gastric emptying to some extent (r ϭ 0.46, P Ͻ 0.0001), whereas sensations experienced in the previous 2 weeks did not.CONCLUSIONS -This prospective study shows that delayed gastric emptying can be observed in 28% of unselected patients with diabetes. Upper gastrointestinal sensations scored during the gastric emptying tests do predict the rate of gastric emptying to some extent and sensation experienced during daily life does not. Diabetes Care 26:3116 -3122, 2003T he prevalence of delayed gastric emptying in patients with diabetes has been subject to debate for several decades. Cross-sectional studies using scintigraphic techniques to measure gastric emptying have shown delayed gastric emptying in patients with diabetes varying from 30 to 60% (1-11). However, there are several important limitations to these studies. First, the vast majority of these studies have been performed in small numbers of patients or in selected patients, which may account for the high percentage of patients showing delayed gastric emptying in some of these studies. Second, none of these studies has been performed during relative euglycemic conditions, whereas recent studies have provided evidence that hyperglycemia has a substantial effect on the rate of gastric emptying (12,13). After taking the aforementioned into account, the prevalence of delayed gastric emptying in diabetic patients who are not selected for gastrointestinal symptoms has yet to be determined.Previous studies have reported a weak association between gastric emptying and upper gastrointestinal symptoms experienced by patients in the period preceding the gastric emptying test, with the exception of the study performed by Jones et al. (10). They studied a large cohort of diabetic subjects over a period Ͼ10 years and reported that abdominal bloating and fullness were as...

show abstract

“…This may be because of the similar orocecal transit of these particles through the gastrointestinal tract for these 2 groups. Many studies have shown that orocecal transit is not altered in diabetic patients without neuropathy (11,23).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that the time taken for orocecal and colorectal transit is longer for diabetic patients than for non-diabetic (ND) individuals (7)(8)(9). However, some other studies did not show any significant difference between diabetic and healthy individuals with respect to gastrointestinal transit (10,11). Currently, radiopaque markers are used for studying gastrointestinal transit (6,9,12,13); these markers allow the characterization of the transit time through each part of the gastrointestinal tract by using different methods and formulas and help determine the total transit time (14).…”

Section: Introductionmentioning

confidence: 99%

Transit of radiopaque particles through the gastrointestinal tract: comparison between type 2 diabetes patients and healthy individuals

Jorge

Matos

Machado

et al. 2012

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

Background/aims: some studies have reported controversial results when comparing the gastrointestinal transit between diabetic and healthy individuals. Therefore, we compared the gastrointestinal transit of radiopaque particles between diabetic and non-diabetic healthy individuals.Methods: abdominal radiographies were performed for 45 type 2 diabetes mellitus patients and 35 healthy individuals (gender and age similar for both groups) at 24 and 72 h after they ingested radiopaque particles. The mean number of particles in the colon was compared for both groups. The data were expressed as mean and standard deviation values.Results: at 24 h, the total number of particles in the colon did not differ significantly for the diabetic and non-diabetic individuals. At 72 hours, the distribution in the diabetic and non-diabetic individuals was as follows: right colon, 0.44 ± 0.88 and 0.26 ± 0.7, respectively (p = 0.8); left colon, 2.6 ± 4.2 and 0.49 ± 1.3 (p < 0.003); and rectosigmoid colon, 2.65 ± 3.8 and 0.80 ± 1.5 (p < 0.005).The mean number of radiopaque particles in the entire colon was 5.7 ± 7.1 and 1.5 ± 2.7 for diabetic and non-diabetic individuals, respectively (p < 0.001).Conclusions: the number of radiopaque particles in the colon did not significantly differ for the diabetic and non-diabetic individuals at 24 h after ingestion but was significantly greater in diabetic individuals at 72 h after ingestion. At 72 h, the mean number of radiopaque particles in the left and rectosigmoid colon were significantly higher in the diabetics than in the non-diabetic individuals.Key words: Transit of radiopaque particles. Diabetes mellitus. INTRODUCTIONGastrointestinal alterations seem to be common in patients with type 2 diabetes mellitus (DM) (1-3), although studies contradicting these observations also exist (4). Some studies have shown that gastrointestinal transit is altered in diabetic patients (5). Several studies have been performed to study the transit of particles through the small intestine and particularly through the colon; however, results of these studies are controversial (6,7). Several studies have shown that the time taken for orocecal and colorectal transit is longer for diabetic patients than for non-diabetic (ND) individuals (7-9). However, some other studies did not show any significant difference between diabetic and healthy individuals with respect to gastrointestinal transit (10,11). Currently, radiopaque markers are used for studying gastrointestinal transit (6,9,12,13); these markers allow the characterization of the transit time through each part of the gastrointestinal tract by using different methods and formulas and help determine the total transit time (14). This is the standard method, based on which the accuracy of other new methods is evaluated (15)(16)(17)(18)(19). Some authors believe that calculating gastrointestinal transit time by using different methods and formulas may produce different outcomes (14). Similarly, the physical characteristics of radiopaque particles can also influence...

show abstract

Gastrointestinal Transit Disorders in Patients with Insulin-Treated Diabetes mellitus

Cited by 114 publications

References 13 publications

Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties

Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Transit of radiopaque particles through the gastrointestinal tract: comparison between type 2 diabetes patients and healthy individuals

Contact Info

Product

Resources

About