title: Diabetes mellitus and gastric emptying: questions and issues in clinical practice.
abstract: It is long known that both type 1 and type 2 diabetes can be associated with changes in gastric emptying; a number of publications have linked diabetes to delayed gastric emptying of variable severity and often with poor relationship to gastrointestinal symptomatology. In contrast, more recent studies have reported accelerated gastric emptying when adjusted for glucose concentration in patients with diabetes, indicating a reciprocal relationship between gastric emptying and ambient glucose concentrations. This review proposes that gastroparesis or gastroparesis diabeticorum, a severe condition characterized by a significant impairment of gastric emptying accompanied by severe nausea, vomiting, and malnutrition, is often overdiagnosed and not well contrasted with delays in gastric emptying. The article offers a clinically relevant definition of gastroparesis that should help differentiate this rare condition from (often asymptomatic) delays in gastric emptying. The fact that delayed gastric emptying can also be observed in non-diabetic individuals under experimental conditions in which hyperglycaemia is artificially induced suggests that a delay in gastric emptying rate when blood glucose concentrations are high is actually an appropriate physiological response to hyperglycaemia, slowing further increases in blood glucose. The article discusses the strengths and weaknesses of various methodologies for assessing gastric emptying, especially with respect to the diabetes population, and reviews newer diabetes therapies that decelerate the rate of gastric emptying. These therapies may be a beneficial tool in managing postprandial hyperglycaemia because they attenuate rapid surges in glucose concentrations by slowing the delivery of meal-derived glucose.
authors.affiliation: University Medical Center St Radboud, Gastroenterology, Nijmegen, The Netherlands. M.Samsom@rvb.umcn.nl
authors.forename: Melvin
authors.initials: M
authors.lastname: Samsom
authors.forename: Adil
authors.initials: A
authors.lastname: Bharucha
authors.forename: John E
authors.initials: JE
authors.lastname: Gerich
authors.forename: Kathrin
authors.initials: K
authors.lastname: Herrmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Limmer
authors.forename: Rainer
authors.initials: R
authors.lastname: Linke
authors.forename: David
authors.initials: D
authors.lastname: Maggs
authors.forename: Jörg
authors.initials: J
authors.lastname: Schirra
authors.forename: Adrian
authors.initials: A
authors.lastname: Vella
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Wörle
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005746:Gastric Emptying / Q000187:drug effects / Q000502:physiology*; D018589:Gastroparesis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans
chemical_list: D001786:Blood Glucose