Measurement of gastric emptying in diabetes

Liza K Phillips; Chris K Rayner; Karen L Jones; Michael Horowitz

doi:10.1016/j.jdiacomp.2014.06.005

Measurement of gastric emptying in diabetes

J Diabetes Complications. 2014 Nov-Dec;28(6):894-903. doi: 10.1016/j.jdiacomp.2014.06.005. Epub 2014 Jun 17.

Authors

Liza K Phillips¹, Chris K Rayner², Karen L Jones³, Michael Horowitz⁴

Affiliations

¹ Discipline of Medicine, The University of Adelaide, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia.
² Discipline of Medicine, The University of Adelaide, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia.
³ Discipline of Medicine, The University of Adelaide, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Australia.
⁴ Discipline of Medicine, The University of Adelaide, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia. Electronic address: michael.horowitz@adelaide.edu.au.

PMID: 25047170
DOI: 10.1016/j.jdiacomp.2014.06.005

Abstract

There has been a substantial evolution of concepts related to disordered gastric emptying in diabetes. While the traditional focus has hitherto related to the pathophysiology and management of upper gastrointestinal symptoms associated with gastroparesis, it is now apparent that the rate of gastric emptying is central to the regulation of postprandial glycemia. This recognition has stimulated the development of dietary and pharmacologic approaches to optimize glycemic control, at least in part, by slowing gastric emptying. With the increased clinical interest in this area, it has proved necessary to expand the traditional indications for gastric emptying studies, and consider the relative strengths and limitations of available techniques. Scintigraphy remains the 'gold standard' for the measurement of gastric emptying, however, there is a lack of standardization of the technique, and the optimal test meal for the evaluation of gastrointestinal symptoms may be discordant from that which is optimal to assess impaired glycemic control. The stable isotope breath test provides an alternative to scintigraphy and can be performed in an office-based setting. The effect of glucagon-like peptide-1 (GLP-1) and its agonists to reduce postprandial glycemia is dependent on the baseline rate of gastric emptying, as well as the magnitude of slowing. Because the effect of exogenous GLP-1 to slow gastric emptying is subject to tachyphylaxis with sustained receptor exposure, 'short acting' or 'prandial' GLP-1 agonists primarily target postprandial glycemia through slowing of gastric emptying, while 'long acting' or 'non-prandial' agents lower fasting glucose primarily through insulinotropic and glucagonostatic mechanisms. Accordingly, the indications for the therapeutic use of these different agents are likely to vary according to baseline gastric emptying rate and glycemic profiles.

Keywords: Gastric emptying; Gastroparesis; Glucose homeostasis; Postprandial glycemia; Scintigraphy; Type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Blood Glucose / metabolism
Diabetes Complications / diagnosis*
Diabetes Complications / etiology
Diabetes Complications / physiopathology
Diabetes Complications / therapy
Diabetes Mellitus / diagnosis
Diabetes Mellitus / physiopathology*
Diabetes Mellitus / therapy
Diagnostic Techniques, Digestive System*
Gastric Emptying / physiology*
Gastroparesis / diagnosis*
Gastroparesis / etiology
Gastroparesis / physiopathology
Gastroparesis / therapy
Humans
Postprandial Period

Substances

Blood Glucose