Relationship Between Gastric Emptying and Diurnal Glycemic Control in Type 1 Diabetes Mellitus: A Randomized Trial

Abstract

<div class="section"> <a class="named-anchor" id="s1"> <!-- named anchor --> </a> <h5 class="section-title" id="d4022501e187">Context:</h5> <p id="d4022501e189">In type 1 diabetes (T1D), delayed gastric emptying (GE) may predispose to a mismatch between insulin delivery and glucose absorption. Previous studies evaluated, only partly, the relationship between delayed GE and postprandial, but not diurnal, glycemia. </p> </div><div class="section"> <a class="named-anchor" id="s2"> <!-- named anchor --> </a> <h5 class="section-title" id="d4022501e192">Objective:</h5> <p id="d4022501e194">To assess the relationship between GE disturbances and glycemic control in T1D and the effects of accelerating GE on glycemic control. </p> </div><div class="section"> <a class="named-anchor" id="s3"> <!-- named anchor --> </a> <h5 class="section-title" id="d4022501e197">Design, Setting, and Participants:</h5> <p id="d4022501e199">This was a randomized placebo-controlled trial in 30 patients with T1D on an insulin pump at an academic medical center. </p> </div><div class="section"> <a class="named-anchor" id="s4"> <!-- named anchor --> </a> <h5 class="section-title" id="d4022501e202">Intervention(s):</h5> <p id="d4022501e204">GE was evaluated with a [ ¹³C]- <i>Spirulina</i> breath test at baseline (GE _baseline), during intravenous saline or erythromycin (2 or 3 mg/kg; GE _iv), and after 7 days of oral erythromycin or placebo (GE _oral). Weighed meals were provided throughout the study. </p> </div><div class="section"> <a class="named-anchor" id="s5"> <!-- named anchor --> </a> <h5 class="section-title" id="d4022501e222">Main Outcome Measure(s):</h5> <p id="d4022501e224">These were GE and continuous glucose monitoring (CGM).</p> </div><div class="section"> <a class="named-anchor" id="s6"> <!-- named anchor --> </a> <h5 class="section-title" id="d4022501e227">Results:</h5> <p id="d4022501e229">The baseline glycosylated hemoglobin was 7.6% ± 0.8% (60 ± 8.7 mmol/mol); 12 patients (40%) had delayed GE; faster GE was associated with a greater postprandial CGM-based glucose, but slower GE was not associated with postprandial hypoglycemia (&lt;70 mg/dL). Intravenous (3 mg/kg) but not oral erythromycin accelerated GE. The relationship between GE and glycemia differed between the postprandial periods and the entire day. After adjusting for carbohydrate intake and insulin consumption, faster GE was associated with more hyperglycemia during the postprandial period but lower glucose values across the entire study. </p> </div><div class="section"> <a class="named-anchor" id="s7"> <!-- named anchor --> </a> <h5 class="section-title" id="d4022501e232">Conclusions:</h5> <p id="d4022501e234">In T1D, pharmacologically mediated acceleration of GE increases postprandial CGM-based glucose. In contrast, delayed GE is associated with greater CGM-based glucose values over the entire day. </p> </div><p class="first" id="d4022501e237">In 30 patients with T1D treated with intravenous, then oral, erythromycin or placebo, faster GE was associated with greater postprandial glucose but lower glucose during the entire day. </p>