Effect of altering gastric emptying on postprandial plasma glucose concentrations following a physiologic meal in type-II diabetic patients

Dig Dis Sci. 2003 Mar;48(3):488-97. doi: 10.1023/a:1022528414264.

Abstract

The purpose of this study was to determine the effects of altering gastric emptying on postprandial plasma glucose concentration after a physiologic meal in patients with type II diabetes mellitus (T II DM). Nine T II DM patients underwent a double-blind, randomized, three-way crossover study, receiving erythromycin 200 mg, morphine 8 mg, or normal saline (placebo) intravenously prior to ingestion of a radiolabeled, dual-isotope, solid-liquid meal. Gastric emptying of solids and liquids and serial plasma glucose, glucagon, and serum insulin concentrations were measured at baseline and for 5 hr after meal ingestion. Erythromycin accelerated and morphine delayed solid- and liquid-phase gastric emptying compared to placebo (P < 0.05). During the first hour, the postprandial plasma glucose concentrations were higher after erythromycin (P < 0.05) and lower after morphine (P < 0.05) compared to placebo. The peak postprandial plasma glucose concentration was higher after erythromycin (P = 0.05) and lower after morphine (P < 0.05) compared to placebo. In conclusion, pharmacologic acceleration of gastric emptying resulted in higher postprandial glucose concentrations, while delaying gastric emptying resulted in lower postprandial glucose concentrations after a physiologic meal in T II DM. These results suggest that administration of opiate analgesics or prokinetic agents to diabetic patients may alter glucose control. Modifying gastric emptying may be helpful in achieving glucose control in T II DM.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / pharmacokinetics
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacokinetics
  • Blood Glucose / analysis
  • Blood Glucose / physiology*
  • Cross-Over Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnostic imaging
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Double-Blind Method
  • Erythromycin / administration & dosage
  • Erythromycin / pharmacology
  • Female
  • Gastric Emptying / drug effects
  • Gastric Emptying / physiology*
  • Gastrointestinal Agents / blood
  • Glucagon / blood
  • Humans
  • Hypoglycemic Agents / blood
  • Insulin / blood
  • Male
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / pharmacokinetics
  • Placebo Effect
  • Postprandial Period / drug effects
  • Postprandial Period / physiology*
  • Radionuclide Imaging
  • Stomach / diagnostic imaging

Substances

  • Analgesics, Opioid
  • Anti-Bacterial Agents
  • Blood Glucose
  • Gastrointestinal Agents
  • Hypoglycemic Agents
  • Insulin
  • Erythromycin
  • Morphine
  • Glucagon