Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
J Clin Endocrinol Metab. 2019 Aug 1;104(8):3311-3319. doi: 10.1210/jc.2018-02736.
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.
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.
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.
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).
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.
胃排空是餐后血糖的主要决定因素，在长期、复杂的 2 型糖尿病（T2DM）中常被延迟。然而，对于血糖控制良好的 T2DM 患者的胃排空情况，信息甚少。
评估与无糖尿病的年轻和老年对照组相比，血糖控制良好的社区 T2DM 患者的胃排空率。
共纳入 111 例 T2DM 患者（饮食治疗组 52 例，二甲双胍单药治疗组 59 例，糖化血红蛋白[HbA1c]6.6%±0.1%/49.0mmol/mol）、18 例年龄和体重指数（BMI）匹配的无糖尿病老年患者和 15 例年轻健康受试者，所有受试者均摄入含有 100μL13C-辛酸的标准化土豆泥餐（368.5kcal）。通过呼吸试验评估胃排空（240 分钟）和血糖情况。
与无糖尿病的年轻受试者相比，老年受试者的胃排空较慢（2.3±0.1 与 3.0±0.1kcal/min，P=0.0008）。然而，与年龄和 BMI 匹配的无糖尿病受试者相比，T2DM 患者的胃排空速度更快（2.8±0.1kcal/min，P=0.0005）。此外，与饮食控制的 T2DM 患者（2.7±0.1kcal/min）相比，二甲双胍治疗的 T2DM 患者（3.0±0.1kcal/min）的胃排空速度更快（P=0.011），尽管两组患者的年龄、BMI、HbA1c 或糖尿病病程无差异。无论是否使用二甲双胍，T2DM 患者餐后血糖升高（t=30 分钟和 60 分钟时的血糖值，t=0 至 120 分钟时的曲线下面积增量）与胃排空率直接相关（P<0.05）。
胃排空随年龄增长而减慢，但血糖控制良好的 T2DM 患者的胃排空速度相对较快。这为通过减缓胃排空来改善这些患者的餐后血糖控制提供了有力的依据。
