title: Relationship between glycemic control and gastric emptying in poorly controlled type 2 diabetes.
abstract: OBJECTIVE
  Acute hyperglycemia delays gastric emptying in patients with diabetes. However, it is not clear whether improved control of glycemia affects gastric emptying in these patients. We investigated whether overnight and short-term (6 mo) improvements in control of glycemia affect gastric emptying.
  
  
  METHODS
  We studied 30 patients with poorly controlled type 2 diabetes (level of glycosylated hemoglobin, >9%). We measured gastric emptying using the [(13)C]-Spirulina platensis breath test on the patients' first visit (visit 1), after overnight administration of insulin or saline, 1 week later (visit 2), and 6 months after intensive therapy for diabetes. We also measured fasting and postprandial plasma levels of C-peptide, glucagon-like peptide 1, and amylin, as well as autonomic functions.
  
  
  RESULTS
  At visit 1, gastric emptying was normal in 10 patients, delayed in 14, and accelerated in 6; 6 patients had gastrointestinal symptoms; vagal dysfunction was associated with delayed gastric emptying (P < .05). Higher fasting blood levels of glucose were associated with shorter half-times of gastric emptying (thalf) at visits 1 (r = -0.46; P = .01) and 2 (r = -0.43; P = .02). Although blood levels of glucose were lower after administration of insulin (132 ± 7 mg/dL) than saline (211 ± 15 mg/dL; P = .0002), gastric emptying thalf was not lower after administration of insulin, compared with saline. After 6 months of intensive therapy, levels of glycosylated hemoglobin decreased from 10.6% ± 0.3% to 9% ± 0.4% (P = .0003), but gastric emptying thalf did not change (92 ± 8 min before, 92 ± 7 min after). Gastric emptying did not correlate with plasma levels of glucagon-like peptide 1 and amylin.
  
  
  CONCLUSIONS
  Two-thirds of patients with poorly controlled type 2 diabetes have mostly asymptomatic yet abnormal gastric emptying. Higher fasting blood levels of glucose are associated with faster gastric emptying. Overnight and sustained (6 mo) improvements in glycemic control do not affect gastric emptying.
authors.affiliation: Clinical and Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota. Electronic address: bharucha.adil@mayo.edu.
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.affiliation: Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Yogish
authors.initials: Y
authors.lastname: Kudva
authors.affiliation: Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ananda
authors.initials: A
authors.lastname: Basu
authors.affiliation: Clinical and Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael
authors.initials: M
authors.lastname: Camilleri
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Low
authors.affiliation: Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Adrian
authors.initials: A
authors.lastname: Vella
authors.affiliation: Division of Biostatistics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D001944:Breath Tests; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005746:Gastric Emptying; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D058228:Islet Amyloid Polypeptide / Q000097:blood; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D058228:Islet Amyloid Polypeptide; D052216:Glucagon-Like Peptide 1
keywords: Autonomic; DM; Diabetes Mellitus; Gastroparesis