Watson, L.E.Xie, C.Wang, X.Li, Z.Phillips, L.K.Sun, Z.Jones, K.L.Horowitz, M.Rayner, C.K.Wu, T.2019-10-162019-10-162019Journal of Clinical Endocrinology and Metabolism (JCEM), 2019; 104(8):3311-33190021-972X1945-7197http://hdl.handle.net/2440/121587CONTEXT: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.en© 2019 Endocrine SocietyHumansDiabetes Mellitus, Type 2MetforminHypoglycemic AgentsAge FactorsAgingGastric EmptyingPostprandial PeriodAdolescentAdultAgedMiddle AgedFemaleMaleYoung AdultIndependent LivingDiet, DiabeticJournal article003011238510.1210/jc.2018-027360004825585000312-s2.0-85068488359466563Xie, C. [0000-0002-0054-9269]Phillips, L.K. [0000-0002-9066-717X]Jones, K.L. [0000-0002-1155-5816]Horowitz, M. [0000-0002-0942-0306]Rayner, C.K. [0000-0002-5527-256X]Wu, T. [0000-0003-1656-9210]