Mechanism of accelerated gastric emptying of liquids and hyperglycemia in patients with type II diabetes mellitus

doi:10.1016/0016-5085(95)90382-8

Gastroenterology

Volume 109, Issue 3, September 1995, Pages 755-765

https://doi.org/10.1016/0016-5085(95)90382-8 Get rights and content

Abstract

$Background & Aims$ : The roles of hyperglycemia in diabetic gastroparesis and gastric delivery in postprandial hyperglycemia of diabetic patients are unclear. The aims of this study were to assess gastric emptying and its relation to postprandial glucose metabolism in patients with asymptomatic non-insulin-dependent diabetes mellitus (NIDDM) and no autonomic neuropathy and to identify motor mechanisms responsible for any accelerated gastric emptying. $Methods$ : Autonomic function, gastric emptying, postprandial glucose metabolism, and hormone levels (glucagon, insulin, cholecystokinin, glucose-dependent insulinotropic polypeptide, neurotensin, and peptide YY) were assessed in healthy volunteers and patients with NIDDM. In a second study, gastric tone and motility were measured in patients with accelerated gastric emptying and in controls. $Results$ : Gastric emptying of solids did not differ in the two groups, but liquids emptied faster in patients with NIDDM (P < 0.02). The rate of entry of ingested glucose into the systemic circulation was similar, but higher postprandial glucagon and lower insulin concentrations led to greater (P < 0.01) postprandial hepatic glucose release. Levels of other enteropeptides, gastric accommodation, and antral motility were similar, but patients with NIDDM had greater proximal gastric phasic contractions than controls (P < 0.05). $Conclusions$ : Excessive hepatic glucose release, not rapid entry of ingested glucose, is the primary cause of postprandial hyperglycemia in patients with NIDDM. Accelerated gastric emptying in patients with nonneuropathic NIDDM is associated with increased proximal stomach phasic contractions.

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Citation Excerpt :
Conversely, impaired hyperglycemia-induced release of amylin, which delays GE, may contribute to rapid GE in diabetes.63 Although a subset of patients with type 2 diabetes have increased plasma glucagon concentrations, higher glucagon concentrations in isolation are unlikely to explain rapid GE of liquids in these patients.64,65 The stomach normally empties nutrients into the small intestine at a tightly regulated rate averaging 2–3 kcal per minute.66,67
Hyperglycemia is implicated as a major risk factor for delayed gastric emptying in diabetes mellitus and vice versa. However, the extent to which hyperglycemia can affect gastric emptying and vice versa and the implications for clinical practice are unclear. We systematically reviewed the evidence for this bidirectional relationship and the effects of pharmacotherapy for diabetes on gastric emptying.
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^☆: Supported in part by grants DK29953 (to R.A.R.) and RR00585 (General Clinical Research Center) from the National Institutes of Health.

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Alimentary tractMechanism of accelerated gastric emptying of liquids and hyperglycemia in patients with type II diabetes mellitus☆

Abstract

Endocrinol Metab Clin North Am

Metabolism

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

J Clin Endocrinol Metab

Regul Pept

Am J Physiol

Gastroenterology

Am J Physiol

Lancet

Gut

Gut

Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum)

Ann Intern Med

Abnormal intestinal motility in diabetics with gastroparesis

Eur J Clin Invest

The relationship between clinical factors and gastrointestinal dysmotility in diabetes mellitus

J Gastrointest Motil

Gastric emptying in patients with insulin-requiring diabetes mellitus

Am J Gastroenterol

Relation of symptoms to impaired stomach, small bowel, and colon motility in long-standing diabetes

Dig Dis Sci

Carbohydrate metabolism in non-insulin-dependent diabetes mellitus

N Engl J Med

Hyperglycaemia slows gastric emptying in type I (insulin-dependent) diabetes mellitus

Diabetologia

Rapid gastric emptying of an oral glucose solution in type 2 diabetic patients

J Nucl Med

Disturbances of the alimentary tract motility and hypermotilinemia in patients with diabetes mellitus

Tohoku J Exp Med

Cardiac autonomic neuropathy in diabetes: comparison of measures of R-R interval variation

Diabetologia

A comparison of cardiovascular reflex tests and spectral analysis of heart rate variability in healthy subjects

Clin Autonom Res

Laboratory evaluation of autonomic failure

Vagal, cholinergic regulation of pancreatic polypeptide secretion

J Clin Invest

Forearm glucose uptake during the oral glucose tolerance test in normal subjects

Diabetes

Alimentary tract
Mechanism of accelerated gastric emptying of liquids and hyperglycemia in patients with type II diabetes mellitus☆