Effect of altering gastric emptying on postprandial plasma glucose concentrations following a physiologic meal in type-II diabetic patients.
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.
Gonlachanvit
Sutep
S
Gastroenterology Section, Department of Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Hsu
Chia-Wen
CW
Boden
Guenther H
GH
Knight
Linda C
LC
Maurer
Alan H
AH
Fisher
Robert S
RS
Parkman
Henry P
HP
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000493:pharmacokinetics; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D001786:Blood Glucose / Q000032:analysis / Q000502:physiology*; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004311:Double-Blind Method; D004917:Erythromycin / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects / Q000502:physiology*; D005765:Gastrointestinal Agents / Q000097:blood; D005934:Glucagon / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000097:blood; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000493:pharmacokinetics; D015990:Placebo Effect; D019518:Postprandial Period / Q000187:drug effects / Q000502:physiology*; D011877:Radionuclide Imaging; D013270:Stomach / Q000000981:diagnostic imaging
D000701:Analgesics, Opioid; D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D005765:Gastrointestinal Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D004917:Erythromycin; D009020:Morphine; D005934:Glucagon