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Relationships between Gastric Emptying, Intragastric Meal Distribution and Blood Glucose Concentrations in Diabetes Mellitus

Departments of Medicine, Nuclear Medicine and Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia

Correspondence: For correspondence reprints or contact: Professor M. Horowitz, Department of Medicine, Royal Adelaide Hospital, North Terrance, Adelaide, South Australia, Australia, 5000.

ABSTRACT

The aim of this study was to evaluate the prevalence of disordered intragastric meal distribution and the relationships between gastric emptying, intragastric distribution, glycemic control and gastrointestinal symptoms in diabetes mellitus. Methods: Eighty-six patients with diabetes mellitus. had measurements of gastric emptying and intragastric distribution of a radioisotopically labeled solid/liquid meal (100 g beef and 150 ml 10% dextrose), glycemic control (plasma glucose concentrations), upper gastrointestinal symptoms (questionnaire) and autonomic nerve function (cardiovascular reflexes). Results were compared to those obtained in 20 normal volunteers. Results: Solid and liquid gastric emptying were delayed in the diabetic patients and correlated weakly. Intragastric meal distribution was also often abnormal, with increased retention of both solid and liquid in the proximal stomach and increased retention of solid but not liquid in the distal stomach. In all patients with increased retention of solid in the proximal stomach, emptying from the total stomach was delayed. Gastric emptying of liquid was slower in those subjects who had a mean plasma glucose >15 mmol/liter during the gastric emptying measurement, when compared to the remainder of the group. Conclusion: In patients with diabetes mellitus, there is a poor relationship between solid and liquid gastric emptying and intragastric meal distribution is frequently abnormal. Interpretation of the results of gastric emptying measurements should consider meal composition and plasma glucose concentrations.

Key Words: gastric emptying • diabetes mellitus • blood glucose • gastrointestinal symptoms • autonomic nerve function

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