Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
J Clin Endocrinol Metab. 2018 Jun 1;103(6):2269-2276. doi: 10.1210/jc.2017-02811.
Diabetes mellitus is associated with gastrointestinal (GI) motility dysfunction, ranging from delayed to accelerated gastric emptying (GE).
To evaluate GE in patients with type 1 diabetes mellitus (T1DM) without chronic complications and to investigate its relation with postprandial glucose and GI hormone responses.
Cross-sectional study.
SETTING/PARTICIPANTS: Forty-two patients with T1DM free of chronic complications referred to Federico II University and 31 healthy controls similar for age, sex, and body mass index.
INTERVENTIONS/MAIN OUTCOME MEASURES: GE was assessed by using the 13C-octanoate breath test with a standardized solid meal. During the meal, plasma glucose, ghrelin, and glucagon-like peptide 1 (GLP-1) responses were assessed, and GI symptoms were evaluated by a specific questionnaire.
Patients with T1DM showed a significantly slower GE half-emptying time (GE t1/2) (113 ± 34 minutes) than did controls (89 ± 17 minutes; P < 0.001). Thirty-six percent of T1DM showed a delayed GE (t1/2 > 120 minutes), whereas all controls showed a normal GE. When patients with T1DM were stratified according to GE t1/2, postmeal glucose response was significantly different between those with delayed and those with normal GE (P = 0.013). In particular, patients with T1DM and delayed GE showed a significantly longer mean time to peak glucose than did patients with normal GE (P = 0.004). In addition, GE t1/2 was an independent predictor of the time to peak glucose (β = 0.329; P = 0.025). GLP-1 and ghrelin responses to the test meal, as well as the prevalence of GI symptoms, were similar between patients with T1DM and controls and between patients with T1DM with normal GE and those with delayed GE.
Delayed GE time is associated with a longer time to peak glucose. GE evaluation could be useful for individualizing the timing of preprandial insulin bolus in patients with T1DM.
糖尿病与胃肠（GI）动力功能障碍有关，范围从胃排空延迟到加速。
评估无慢性并发症的 1 型糖尿病（T1DM）患者的胃排空情况，并研究其与餐后血糖和 GI 激素反应的关系。
横断面研究。
地点/参与者：42 名无慢性并发症的 T1DM 患者和 31 名年龄、性别和体重指数相似的健康对照者被送到 Federico II 大学。
干预措施/主要观察指标：采用 13C-辛酸呼气试验和标准化固体餐评估胃排空。在进餐过程中，评估血浆葡萄糖、胃饥饿素和胰高血糖素样肽 1（GLP-1）的反应，并通过特定的问卷评估 GI 症状。
T1DM 患者的胃排空半排空时间（GE t1/2）（113 ± 34 分钟）明显慢于对照组（89 ± 17 分钟；P < 0.001）。36%的 T1DM 患者表现出胃排空延迟（t1/2 > 120 分钟），而所有对照组均表现出正常的胃排空。根据 GE t1/2 将 T1DM 患者分层后，胃排空延迟和正常的 T1DM 患者餐后血糖反应有显著差异（P = 0.013）。特别是，T1DM 患者和胃排空延迟的患者的峰值血糖时间明显长于胃排空正常的患者（P = 0.004）。此外，GE t1/2 是峰值血糖时间的独立预测因子（β = 0.329；P = 0.025）。测试餐的 GLP-1 和胃饥饿素反应以及 GI 症状的发生率在 T1DM 患者和对照组之间以及 T1DM 患者中胃排空正常和延迟之间相似。
胃排空时间延迟与峰值血糖时间延长有关。胃排空评估可用于个体化 T1DM 患者餐前胰岛素剂量的时间。
