Slow Gastric Emptying in Type I Diabetes: Relation to Autonomic and Peripheral Neuropathy, Blood Glucose, and Glycemic Control

Merio, René; Festa, Andreas; Bergmann, Helmar; Eder, Thomas; Eibl, N; Stacher-Janotta, G; Weber, Ute; Budka, Christine; Heckenberg, Andrea; Bauer, P.; Francesconi, Mario; Schernthaner, Guntram; Stacher, G

doi:10.2337/diacare.20.3.419

Cited by 92 publications

(62 citation statements)

References 36 publications

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“…The emptying of a semisolid 1168 kilo-Joule meal (250 ml milk, 15 g sugar, 14 g maize starch and cinnamon) mixed with 72 MBq [ 99 m Tc]phytate was recorded scintigraphically [8]. Recording began at the end of meal ingestion and lasted 50 min.…”

Section: Introductionmentioning

confidence: 99%

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Holzäpfel¹,

Festa

Stacher-Janotta

et al. 1999

Diabetologia

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Previous investigations suggested the actual blood glucose concentration to be a determinant of the rate of gastric emptying. In healthy subjects, experimentally induced hyperglycaemia slowed emptying [1±3] and in patients with Type I (insulin-dependent) diabetes mellitus, emptying was slower during induced hyperglycaemia than in euglycaemia [3,4]. In cross-sectional investigations in diabetic patients, these relations between naturally occurring, longerlasting increases in blood glucose concentrations and gastric emptying were less clear or even indiscernible [5±9]. To explain the impact of actual, longer-lasting increases in blood glucose concentrations and of their reduction on gastric emptying, we studied gastric emptying in patients with Type II (non-insulin-dependent) diabetes mellitus and secondary failure to respond to oral hypoglycaemic therapy firstly before treatment readjustment and secondly 1 week thereafter, when glycaemia was greatly decreased. Diabetologia (1999) AbstractAims/hypothesis. Hyperglycaemia that is induced short-term slows gastric emptying in healthy subjects and patients with diabetes mellitus. Little information is available on the impact of longer-lasting, naturally occurring blood glucose increases and their reduction to euglycaemic values. We studied the relation between gastric emptying and pre-prandial and postprandial blood glucose concentrations in patients with Type II (non-insulin-dependent) diabetes mellitus and secondary failure to respond to oral hypoglycaemic treatment (a) before readjusting hypoglycaemic therapy and (b) 1 week thereafter. Methods. We studied 9 female and 1 male patient (age 60±78 years, BMI 21.9±32.5 kg/m 2 , diabetes duration 3±33 years, HbA 1 c 8.8±13.2 %). Gastric emptying of a radiolabelled semisolid 1168 kJ meal was recorded scintigraphically.Results. Blood glucose concentration pre-prandial and postprandial was considerably lower subsequent to than before therapy readjustment in all patients (fasting, 7.9 mmol/l ± 1.5 SD vs 11.7 ± 1.7 mmol/l; 60 min postprandial, 11.7 ± 2.0 vs 15.4 ± 2.2 mmol/l). By contrast, gastric emptying was unchanged (residual radioactivity in stomach 50 min postprandial 65.7 ± 14.1 % vs 66.5 ± 12.9 %). There was no relation between emptying and either fasting blood glucose concentration or its postprandial increase. Conclusion/interpretation. The data do not support a major impact of actual, longer-lasting, naturally occurring blood glucose concentrations upon the rate of gastric emptying in patients with Type II diabetes. [Diabetologia (1999

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Section: Introductionmentioning

confidence: 99%

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Holzäpfel¹,

Festa

Stacher-Janotta

et al. 1999

Diabetologia

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“…He had not showngastroparetic symptoms such as nausea, vomiting or epigastric discomfort, which may indicate silent gastroparesis (12). Gastric hypomotility in diabetes mellitus is believed to be due to diabetic autonomic neuropathy (1,4) or acute blood glucose change (5,6). Gastric hypomotility is related to the degree of autonomic neuropathy, but not to peripheral neuropathy, actual blood glucose and HbAlc (4).…”

Section: Discussionmentioning

confidence: 99%

“…Gastric hypomotility in diabetes mellitus is believed to be due to diabetic autonomic neuropathy (1,4) or acute blood glucose change (5,6). Gastric hypomotility is related to the degree of autonomic neuropathy, but not to peripheral neuropathy, actual blood glucose and HbAlc (4). During the clinical course, acute blood glucose changes (hyperglycemia-hypoglycemia) were not found in this patient.…”

Section: Discussionmentioning

confidence: 99%

“…The Schellong test (standardized test) reflects autonomic nervous function ( 13). Approximately 80%of severe autonomic neuropathic diabetic paients with a fall in systolic blood pressure of 20 mmHg or more have gastric emptying (4). Heart rate variability, based on the analysis of the time interval between two electrocardiograph R waves (RR interval), is primarily caused by the interaction between the sympathetic and parasympathetic nerve system activities.…”

Section: Discussionmentioning

confidence: 99%

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Acute Gastric Dilatation Accompanied by Diabetes Mellitus.

Nagai¹,

Yokoo²,

Tomizawa³

et al. 2001

Intern. Med.

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A 72-year-old man with diabetic triopathy was hospitalized with methicillin resistant staphylococcus aureus pneumonia. Six hours after the admission, his abdomenwas fully expanded. An abdominal X-ray showed gastric dilatation. After insertion of a gastric tube to extract gastric air, his abdomen was flat and gastric dilatation improved. A positive Schellong test and decreased coefficient of RR interval in electrocardiogram variation indicated autonomicneuropathy, which may explain the reason for gastric hypomotility. Acute gastric dilatation in this patient may have occurred due to gastric hypomotility as a result of diabetic autonomic neuropathy in addition to gastric motility inhibition resulting from gastric autonomic nerve stimulation by bacterial toxin. (Internal Medicine 40: 320-323, 2001)

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“…43 In the cat, delayed gastric emptying was reported in association with pylorospasm, 44 hypertrophic gastropathy, 45 and dysautonomia. 46 Delayed gastric emptying commonly is associated with human type I and type II diabetes 47,48 and has been demonstrated in experimentally induced diabetes in dogs. 49 The prevalence of delayed gastric emptying in diabetic dogs warrants investigation, particularly because erratic delivery of nutrients to the small intestine could contribute to poor glycemic control.…”

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confidence: 99%

A Review of Methods for Assessment of the Rate of Gastric Emptying in the Dog and Cat: 1898–2002

Wyse

McLellan

Dickie

et al. 2003

Veterinary Internal Medicne

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Gastric emptying is the process by which food is delivered to the small intestine at a rate and in a form that optimizes intestinal absorption of nutrients. The rate of gastric emptying is subject to alteration by physiological, pharmacological, and pathological conditions. Gastric emptying of solids is of greater clinical significance because disordered gastric emptying rarely is detectable in the liquid phase. Imaging techniques have the disadvantage of requiring restraint of the animal and access to expensive equipment. Radiographic methods require administration of test meals that are not similar to food. Scintigraphy is the gold standard method for assessment of gastric emptying but requires administration of a radioisotope. Magnetic resonance imaging has not yet been applied for assessment of gastric emptying in small animals. Ultrasonography is a potentially useful, but subjective, method for assessment of gastric emptying in dogs. Gastric tracer methods require insertion of gastric or intestinal cannulae and are rarely applied outside of the research laboratory. The paracetamol absorption test has been applied for assessment of liquid phase gastric emptying in the dog, but requires IV cannulation. The gastric emptying breath test is a noninvasive method for assessment of gastric emptying that has been applied in dogs and cats. This method can be carried out away from the veterinary hospital, but the effects of physiological and pathological abnormalities on the test are not known. Advances in technology will facilitate the development of reliable methods for assessment of gastric emptying in small animals.Key words: Barium-impregnated polyethylene spheres; Breath test; Radiography; Scintigraphy; Ultrasonography.T he important role of the stomach in the digestion of food has been recognized for many centuries. The term ''pylorus'' dates from before the 5th century and is derived from the Greek, meaning ''keeper of the gate,'' an indication that early physicians had some understanding of the physiological function of gastric emptying. The rate of gastric emptying was assessed noninvasively for the 1st time in 1898, when the Harvard physiologist, W.B. Cannon, used X-rays to trace the outline of a radiopaque meal passing through the stomach of a cat (Fig 1).1 Over the next 6 years, Cannon used this method to characterize the functional significance of fundic and antral contractions and demonstrated the effect of emotion and food on the rate of gastric emptying.1,2 Together, these studies formed the cornerstones of the study of gastric motility, and Cannon's findings continue to influence our understanding of gastric emptying to this day. Indeed, over 100 years later, the radiographic tracing of gastric emptying remains the most commonly applied method for assessment of gastric motility in veterinary medicine. 3More recently, the dog has been used as an animal model for the study of human gastric emptying in many physiological and pharmacological studies, and gastric emptying is now more clearly understood in...

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Slow Gastric Emptying in Type I Diabetes: Relation to Autonomic and Peripheral Neuropathy, Blood Glucose, and Glycemic Control

Abstract: Slow gastric emptying in patients with type I diabetes seems related to the degree of autonomic neuropathy but not to peripheral neuropathy, actual blood glucose, and glycemic control.

Cited by 92 publications

References 36 publications

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Acute Gastric Dilatation Accompanied by Diabetes Mellitus.

A Review of Methods for Assessment of the Rate of Gastric Emptying in the Dog and Cat: 1898–2002

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