Influence of gastric emptying on the control of postprandial glycemia: physiology and therapeutic implications

Objective:to identify evidence in the literature on the possible risk factors for the risk of unstable blood glucose diagnosis in individuals with type 2 diabetes mellitus, and to compare them with the risk factors described by NANDA International. Method:an integrative literature review guided by the question: what are the risk factors for unstable blood glucose level in people with type 2 diabetes mellitus? Primary studies were included whose outcomes were variations in glycemic levels, published in English, Portuguese or Spanish, in PubMed or CINAHL between 2010 and 2015. Results:altered levels of glycated hemoglobin, body mass index>31 kg/m2, previous history of hypoglycemia, cognitive deficit/dementia, autonomic cardiovascular neuropathy, comorbidities and weight loss corresponded to risk factors described in NANDA International. Other risk factors identified were: advanced age, black skin color, longer length of diabetes diagnosis, daytime sleepiness, macroalbuminuria, genetic polymorphisms, insulin therapy, use of oral antidiabetics, and use of metoclopramide, inadequate physical activity and low fasting glycemia. Conclusions:risk factors for the diagnosis, risk for unstable blood glucose level, for persons with type 2 diabetes mellitus were identified, and 42% of them corresponded to those of NANDA International. These findings may contribute to the practice of clinical nurses in preventing the deleterious effects of glycemic variation.

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“…This interaction induces glucose-dependent insulin secretion and inhibits glucagon secretion, leading to postprandial hyperglycemia 26 , 44 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for unstable blood glucose level: integrative review of the risk factors related to the nursing diagnosis

Teixeira¹,

Tsukamoto

Lopes

et al. 2017

Rev. Latino-Am. Enfermagem

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“…A key determinant of postprandial hyperglycemia is the rate of gastric emptying after ingesting a meal, which varies according to extrinsic and intrinsic factors [13]. Extrinsic factors that affect gastric emptying include the caloric content and macrocomposition of a meal [13].…”

Section: Physiological Responses Following a Mealmentioning

confidence: 99%

“…Extrinsic factors that affect gastric emptying include the caloric content and macrocomposition of a meal [13]. After a meal is ingested, food in the intestine leads to the release of incretin hormones such as glucosedependent insulinotropic peptide (GIP) and glucagon-like peptide 1 (GLP-1) from the gut [14,15].…”

Section: Physiological Responses Following a Mealmentioning

confidence: 99%

“…The effects of GLP-1 are several: (1) it stimulates the hypothalamus to decrease appetite and, through neural connections to the vagus, inhibits gastric emptying; (2) it increases insulin and reduces glucagon secretion; and (3) it triggers the release of insulin from the pancreatic β-cells along with the hormone amylin which, like incretins, acts on the vagus to reduce gastric emptying [13,16]. In addition to extrinsic regulation of gastric emptying, the process is regulated intrinsically via parasympathetic signals in response to, for example, hyperglycemia [13].…”

Section: Physiological Responses Following a Mealmentioning

confidence: 99%

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Impact of postprandial glucose control on diabetes-related complications: How is the evidence evolving?

Madsbad

2016

Journal of Diabetes and its Complications

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“…Longer use of gluten and synthetic DPP IV inhibitors have been shown to influence gastric emptying and transit time significantly. It is even so that deceleration and slowing of transit time are considered the most important mechanisms by which DPP IV inhibitors influence glucose homeostasis [ 56 , 61 , 62 ].…”

Section: Dpp IV Inhibition By Gluten Intakementioning

confidence: 99%

The opioid effects of gluten exorphins: asymptomatic celiac disease

Pruimboom

Punder

2015

J Health Popul Nutr

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Gluten-containing cereals are a main food staple present in the daily human diet, including wheat, barley, and rye. Gluten intake is associated with the development of celiac disease (CD) and related disorders such as diabetes mellitus type I, depression, and schizophrenia. However, until now, there is no consent about the possible deleterious effects of gluten intake because of often failing symptoms even in persons with proven CD. Asymptomatic CD (ACD) is present in the majority of affected patients and is characterized by the absence of classical gluten-intolerance signs, such as diarrhea, bloating, and abdominal pain. Nevertheless, these individuals very often develop diseases that can be related with gluten intake. Gluten can be degraded into several morphine-like substances, named gluten exorphins. These compounds have proven opioid effects and could mask the deleterious effects of gluten protein on gastrointestinal lining and function. Here we describe a putative mechanism, explaining how gluten could “mask” its own toxicity by exorphins that are produced through gluten protein digestion.

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Influence of gastric emptying on the control of postprandial glycemia: physiology and therapeutic implications

Cited by 13 publications

References 29 publications

Risk factors for unstable blood glucose level: integrative review of the risk factors related to the nursing diagnosis

Risk factors for unstable blood glucose level: integrative review of the risk factors related to the nursing diagnosis

Impact of postprandial glucose control on diabetes-related complications: How is the evidence evolving?

The opioid effects of gluten exorphins: asymptomatic celiac disease

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