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Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control – published online 04/10/2022

jalleh graphical abstract

Ryan J. Jalleh, Karen L. Jones, Christopher K. Rayner, Chinmay S. Marathe, Tongzhi Wu, Michael Horowitz

Gastric emptying is central to the pathogenesis and rational management of type 1 and type 2 diabetes. In this issue, Jalleh et al ( review the effects of diabetes and its treatment on gastric emptying. The authors discuss how gastric emptying is delayed (i.e. gastroparesis) in 30–50% of people with longstanding, complicated type 1 or type 2 diabetes. In contrast, in well-controlled type 2 diabetes, gastric emptying is often abnormally rapid. Upper gastrointestinal symptoms, which should be assessed routinely using a validated instrument, occur frequently, but the relationship of symptoms with disordered gastric emptying is not simply ‘cause-and-effect’. The longstanding therapeutic approach of making the stomach ‘pump’ better has, predictably, proven unsuccessful. The authors go on to outline how gastric emptying, even when normal, is a key determinant of postprandial blood glucose levels. In insulin-treated diabetes, disordered gastric emptying may predispose an individual to hypoglycaemia/increased blood glucose variability. Both short- and long-acting glucagon-like peptide-1 receptor agonists slow gastric emptying to diminish postprandial glycaemic excursions. The authors conclude that measurement of gastric emptying, using a precise technique, should be incorporated in clinical trials of novel therapies that lower postprandial glucose. The figures from this review are available as a downloadable slideset.

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