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Type: Journal article
Title: Gastric emptying in patients with well-controlled type 2 diabetes compared with young and older control subjects without diabetes
Author: Watson, L.E.
Xie, C.
Wang, X.
Li, Z.
Phillips, L.K.
Sun, Z.
Jones, K.L.
Horowitz, M.
Rayner, C.K.
Wu, T.
Citation: Journal of Clinical Endocrinology and Metabolism, 2019; 104(8):3311-3319
Publisher: Endocrine Society
Issue Date: 2019
ISSN: 0021-972X
Statement of
Linda E Watson, Cong Xie, Xuyi Wang, Ziyi Li, Liza K Phillips, Zilin Sun, Karen L Jones, Michael Horowitz, Christopher K Rayner, Tongzhi Wu
Abstract: CONTEXT:Gastric emptying is a major determinant of postprandial glycemia and is often delayed in long-standing, complicated type 2 diabetes mellitus (T2DM). However, there is little information about gastric emptying in well-controlled T2DM. OBJECTIVE:To evaluate the rate of gastric emptying in community-based patients with relatively well-controlled T2DM compared with young and older control subjects without diabetes. PARTICIPANTS AND DESIGN:A total of 111 patients with T2DM managed by diet (n = 52) or metformin monotherapy (n = 59) (HbA1c 6.6 ± 0.1%/49.0 ± 0.9 mmol/mol), 18 age- and body mass index (BMI)-matched older subjects without diabetes, and 15 young healthy subjects consumed a standardized mashed potato meal (368.5 kcal) containing 100 μL 13C-octanoic acid. Gastric emptying (by breath test) and blood glucose were evaluated over 240 minutes. RESULTS:Gastric emptying was slower in the older than in the young subjects without diabetes (2.3 ± 0.1 vs 3.0 ± 0.1 kcal/min, P = 0.0008). However, relative to the age- and BMI-matched subjects without diabetes, gastric emptying (2.8 ± 0.1 kcal/min) was faster in patients with T2DM (P = 0.0005). Furthermore, gastric emptying was faster in the metformin-treated (3.0 ± 0.1 kcal/min) than in the diet-controlled (2.7 ± 0.1 kcal/min) patients with T2DM (P = 0.011), although there were no differences in age, BMI, HbA1c, or the duration of known diabetes. The increments in blood glucose (at t = 30 and 60 minutes and the incremental area under the curve during t = 0 to 120 minutes) after the meal were related directly to the rate of gastric emptying in the subjects with T2DM regardless of treatment with or without metformin (P < 0.05 each). CONCLUSIONS:Gastric emptying is slowed with aging but otherwise is relatively more rapid in patients with well-controlled T2DM. This provides a strong rationale for slowing gastric emptying to improve postprandial glycemic control in these patients.
Keywords: Humans
Diabetes Mellitus, Type 2
Hypoglycemic Agents
Age Factors
Gastric Emptying
Postprandial Period
Middle Aged
Young Adult
Independent Living
Diet, Diabetic
Rights: © 2019 Endocrine Society
DOI: 10.1210/jc.2018-02736
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