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Jalleh RJ, Phillips L, Umapathysivam MM, Jones KL, Marathe CS, Watson LE, Bound M, Rayner CK, Horowitz M. Gastric emptying during and following resolution of moderate diabetic ketoacidosis in type 1 diabetes: a case series. BMJ Open Diabetes Res Care 2024; 12:e003854. [PMID: 38575155 PMCID: PMC11002382 DOI: 10.1136/bmjdrc-2023-003854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION To use the 'gold standard' technique of scintigraphy to quantify gastric emptying (GE) as soon as practicable during an admission with diabetic ketoacidosis (DKA) and following its resolution at least 7 days later. RESEARCH DESIGN AND METHODS Five patients with type 1 diabetes, age 29±12 years; Body Mass Index 23±3 kg/m2; hemoglobin A1c 11.3%±1.9%, were studied during an admission with DKA and following its resolution. Solid and liquid GE were measured using scintigraphy. Solid emptying was assessed via the percentage intragastric retention at 100 min and that of liquid by the 50% emptying time. RESULTS There was no difference in either solid or liquid GE at the initial study compared with the follow-up. Median (IQR) solid retention was 47±20 versus 38%±33%, respectively; p=0.31, and time to empty 50% of liquid was 37±25 min versus 35±15 min, p=0.31, at the initial and follow-up GE study, respectively. CONCLUSIONS GE of solids and liquids is not affected by moderate DKA, inferring that earlier reintroduction of oral intake may be appropriate.
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Affiliation(s)
- Ryan J Jalleh
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Liza Phillips
- Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Mahesh M Umapathysivam
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Karen L Jones
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Chinmay S Marathe
- Endocrine and Metabolic Unit, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Linda E Watson
- Discipline of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Michelle Bound
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Christopher K Rayner
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Michael Horowitz
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
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Jalleh RJ, Jones KL, Nauck M, Horowitz M. Accurate Measurements of Gastric Emptying and Gastrointestinal Symptoms in the Evaluation of Glucagon-like Peptide-1 Receptor Agonists. Ann Intern Med 2023; 176:1542-1543. [PMID: 37931267 DOI: 10.7326/m23-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Affiliation(s)
- Ryan J Jalleh
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South Australia, Australia (R.J.J., K.L.J., M.H.)
| | - Karen L Jones
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South Australia, Australia (R.J.J., K.L.J., M.H.)
| | - Michael Nauck
- Diabetes Endocrinology, Metabolism Section, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University, Bochum, Germany (M.N.)
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South Australia, Australia (R.J.J., K.L.J., M.H.)
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Jalleh RJ, Marathe CS, Trahair LG, Jones KL, Horowitz M. A Biphasic Glucose Response during an Oral Glucose Tolerance Test Is Associated with Greater Plasma Insulin and GLP-1 Responses and a Reduction in 1-Hour Glucose but Does Not Relate to the Rate of Gastric Emptying in Healthy, Older Adults. Nutrients 2023; 15:3889. [PMID: 37764673 PMCID: PMC10534830 DOI: 10.3390/nu15183889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The pattern of the plasma glucose response curve during an oral glucose tolerance test (OGTT) is of prognostic significance with "biphasic" when compared with "monophasic" patterns being associated with greater insulin sensitivity/secretion and a reduced risk of progression to diabetes. The relationships of the glucose response curves with gastric emptying and incretin hormone secretion are not known. METHODS Thirty-six adults (age > 65 years) without known diabetes consumed a 300 mL drink containing 75 g glucose and 150 mg C13-acetate at baseline and follow-up after 5.8 ± 0.1 years. Plasma glucose, glucagon-like peptide-1 (GLP-1), glucose independent insulinotropic polypeptide (GIP) and insulin were measured, and participants classified according to the pattern of their glucose response. Gastric emptying was measured on breath samples (stable isotope breath test). RESULTS At baseline, 22 participants had a "monophasic" and 14 a "biphasic" glucose response. The 1 h plasma glucose response curve was greater and the GLP-1 AUC0-120 min and insulin secretion lower in the monophasic group. There were no differences in gastric emptying, GIP or insulin sensitivity. At the follow-up, the 1 h glucose response curve was greater again, while GLP-1 AUC0-120 min was lower in the monophasic group. CONCLUSIONS A biphasic curve is associated with a higher 60 min glucose response curve and increases in GLP-1, but no difference in either GIP or gastric emptying.
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Affiliation(s)
- Ryan J Jalleh
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Endocrine and Diabetes Services, Northern Adelaide Local Health Network, Adelaide, SA 5112, Australia
| | - Chinmay S Marathe
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Laurence G Trahair
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Karen L Jones
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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Jalleh RJ, Trahair LG, Wu T, Standfield S, Feinle‐Bisset C, Rayner CK, Horowitz M, Jones KL. Effect of gastric distension with concurrent small intestinal saline or glucose infusion on incretin hormone secretion in healthy individuals: A randomized, controlled, crossover study. Diabetes Obes Metab 2023; 25:1849-1854. [PMID: 36864654 PMCID: PMC10947269 DOI: 10.1111/dom.15042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
AIM To evaluate the effect of gastric distension, induced using a gastric 'barostat', on the secretion of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) in the presence and absence of small intestinal nutrients in healthy individuals. MATERIALS AND METHODS Eight healthy participants (two females, six males, mean age 69.3 ± 1.2 years, body mass index 23.5 ± 0.8 kg/m2 ) were each studied on four occasions when they received an intraduodenal infusion of either (i) 0.9% saline or (ii) glucose delivered at a rate of 3 kcal/min both with, and without, an intragastric balloon with the pressure set to 8 mmHg above the intragastric minimum distending pressure. RESULTS Following intraduodenal saline or glucose infusion, there was no difference in plasma GLP-1 with or without gastric distension (P = 1.00 for both saline and glucose infusions). There was also no difference in plasma GIP with or without gastric distension (P = 1.00 for saline infusion and P = .99 for glucose infusion). CONCLUSIONS Gastric distension, either alone or during small intestinal glucose exposure, does not stimulate incretin hormone secretion significantly in healthy humans.
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Affiliation(s)
- Ryan J. Jalleh
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
- Diabetes and Endocrine ServicesNorthern Adelaide Local Health NetworkAdelaideAustralia
| | - Laurence G. Trahair
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
| | - Tongzhi Wu
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
| | - Scott Standfield
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
| | - Christine Feinle‐Bisset
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
| | - Christopher K. Rayner
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Department of Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideAustralia
| | - Michael Horowitz
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | - Karen L. Jones
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
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Xie C, Jalleh RJ, Watson LE, Huang W, Sun Y, Jones KL, Horowitz M, Rayner CK, Wu T. Determinants of blood glucose concentrations following a high carbohydrate meal in type 2 diabetes: A multiple linear regression analysis. Diabetes Res Clin Pract 2023; 198:110606. [PMID: 36893852 DOI: 10.1016/j.diabres.2023.110606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/31/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
This study showed that in relatively well-controlled type 2 diabetes blood glucose levels after a high carbohydrate meal were associated positively with fasting blood glucose, but also positively with gastric emptying in the first hour and negatively with the increments in plasma glucagon-like peptide-1 (GLP-1) in the later postprandial phase.
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Affiliation(s)
- Cong Xie
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Ryan J Jalleh
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Linda E Watson
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Weikun Huang
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Yixuan Sun
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Christopher K Rayner
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia.
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Jalleh RJ, Jones KL, Rayner CK, Marathe CS, Wu T, Horowitz M. Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control. Diabetologia 2022; 65:1981-1993. [PMID: 36194250 PMCID: PMC9630190 DOI: 10.1007/s00125-022-05796-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/01/2022] [Indexed: 01/19/2023]
Abstract
Gastric emptying is a major determinant of postprandial blood glucose, accounting for ~35% of variance in peak glucose in both healthy individuals and those with type 2 diabetes. Gastric emptying is frequently disordered in individuals with diabetes (both abnormally delayed and accelerated). Delayed gastric emptying, i.e. diabetic gastroparesis, may be linked to upper gastrointestinal symptoms for which current treatment remains suboptimal; pharmacological acceleration of delayed emptying is only weakly associated with symptom improvement. Accordingly, the relationship between symptoms and delayed gastric emptying is not simply 'cause and effect'. In insulin-treated patients, disordered gastric emptying, even when not associated with gastrointestinal symptoms, can cause a mismatch between the onset of insulin action and the availability of absorbed carbohydrate, leading to suboptimal glycaemic control. In patients with type 2 diabetes, interventions that slow gastric emptying, e.g. glucagon-like peptide-1 receptor agonists, reduce postprandial blood glucose. This review focuses on recent insights into the impact of gastric emptying on postprandial blood glucose, effects of diabetes therapy on gastric emptying and the management of disordered gastric emptying in diabetes. In view of the broad relevance of gastric emptying to diabetes management, it is important that future clinical trials evaluating novel therapies that may affect gastric emptying should quantify the latter with an appropriate technique, such as scintigraphy or a stable isotope breath test.
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Affiliation(s)
- Ryan J Jalleh
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Chinmay S Marathe
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tongzhi Wu
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
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Jalleh RJ, Xie C, Deane AM, Plummer MP, Jones KL, Horowitz M, Kar P. One-hour plasma glucose level after a 75 g oral glucose load and its relationship to gastric emptying in survivors of critical illness and stress hyperglycaemia. CRIT CARE RESUSC 2022; 24:268-271. [PMID: 38046216 PMCID: PMC10692590 DOI: 10.51893/2022.3.oa6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: A 1-hour plasma glucose level ≥ 8.6 mmol/L in a 75 g oral glucose tolerance test has been strongly associated with increased morbidity and mortality in outpatients without diabetes. Our primary aim was to evaluate the 1-hour plasma glucose level in a 75 g glucose tolerance test in survivors of critical illness with stress hyperglycaemia at 3 months after intensive care unit (ICU) discharge, with the secondary aims to evaluate the 2-hour plasma glucose level, glycated haemoglobin (HbA1c), and gastric emptying. Design:Post hoc analysis of a single-centre, prospective cohort study. Setting: Single-centre, tertiary referral, mixed medical-surgical ICU. Participants: Consecutively admitted patients aged ≥ 18 years who developed stress hyperglycaemia and survived to hospital discharge were eligible. Interventions: Participants returned at 3 months after ICU discharge and underwent a 75 g oral glucose tolerance test. Main outcome measures: One- and 2-hour post load plasma glucose level, HbA1c, and assessment of gastric emptying via an isotope breath test. Results: Thirty-five patients (12 females; mean age, 58.5 years [SD, 10.5]; mean HbA1c, 37.4 mmol/mol [SD, 7.0]) attended the followup. In 32/35 patients (91%) the 1-hour post load plasma glucose level was ≥ 8.6 mmol/L. There was a positive correlation between the plasma glucose level at 1 hour (r2 = 0.21; P = 0.006), but no correlation between the 2-hour glucose level (r2 = 0.006; P = 0.63) and gastric emptying. Conclusion: Glucose intolerance, when defined as 1-hour glucose level ≥ 8.6 mmol/L following a 75 g oral glucose load, persists at 3 months in most survivors of stress hyperglycaemia and is dependent on the rate of gastric emptying. Longitudinal studies to characterise mechanisms underlying dysglycaemia and progression to diabetes in individuals with stress hyperglycaemia are indicated.
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Affiliation(s)
- Ryan J. Jalleh
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Cong Xie
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Adam M. Deane
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mark P. Plummer
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Karen L. Jones
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Palash Kar
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
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Jalleh RJ, Rayner CK, Jones KL, Horowitz M. Isseki nichō (one stone, two birds): a dual incretin receptor agonist for type 2 diabetes. Lancet Diabetes Endocrinol 2022; 10:610-611. [PMID: 35914541 DOI: 10.1016/s2213-8587(22)00193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Ryan J Jalleh
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia; Diabetes and Endocrine Services, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Christopher K Rayner
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Karen L Jones
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia; Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Michael Horowitz
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia; Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, SA 5000, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia.
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Jalleh RJ, Wu T, Jones KL, Rayner CK, Horowitz M, Marathe CS. Relationships of Glucose, GLP-1, and Insulin Secretion With Gastric Emptying After a 75-g Glucose Load in Type 2 Diabetes. J Clin Endocrinol Metab 2022; 107:e3850-e3856. [PMID: 35608823 PMCID: PMC9387705 DOI: 10.1210/clinem/dgac330] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The relationships of gastric emptying (GE) with the glycemic response at 120 minutes, glucagon-like peptide-1 (GLP-1), and insulin secretion following a glucose load in type 2 diabetes (T2D) are uncertain. OBJECTIVE We evaluated the relationship of plasma glucose, GLP-1, and insulin secretion with GE of a 75-g oral glucose load in T2D. DESIGN Single-center, cross-sectional, post hoc analysis. SETTING Institutional research center. PARTICIPANTS 43 individuals with T2D age 65.6 ± 1.1 years, hemoglobin A1c 7.2 ± 1.0%, median duration of diabetes 5 years managed by diet and/or metformin. INTERVENTION Participants consumed the glucose drink radiolabeled with 99mTc-phytate colloid following an overnight fast. GE (scintigraphy), plasma glucose, GLP-1, insulin, and C-peptide were measured between 0 and 180 minutes. MAIN OUTCOME MEASURES The relationships of the plasma glucose at 120 minutes, plasma GLP-1, and insulin secretion (calculated by Δinsulin0-30/ Δglucose0-30 and ΔC-peptide0-30/Δglucose0-30) with the rate of GE (scintigraphy) were evaluated. RESULTS There were positive relationships of plasma glucose at 30 minutes (r = 0.56, P < 0.001), 60 minutes (r = 0.57, P < 0.001), and 120 minutes (r = 0.51, P < 0.001) but not at 180 minutes (r = 0.13, P = 0.38), with GE. The 120-minute plasma glucose and GE correlated weakly in multiple regression models adjusting for age, GLP-1, and insulin secretion (P = 0.04 and P = 0.06, respectively). There was no relationship of plasma GLP-1 with GE. Multiple linear regression analysis indicated that there was no significant effect of GE on insulin secretion. CONCLUSION In T2D, while insulin secretion is the dominant determinant of the 120-minute plasma glucose, GE also correlates. Given the relevance to interpreting the results of an oral glucose tolerance test, this relationship should be evaluated further. There appears to be no direct effect of GE on either GLP-1 or insulin secretion.
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Affiliation(s)
- Ryan J Jalleh
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tongzhi Wu
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Chinmay S Marathe
- Correspondence: Chinmay S. Marathe, MBBS, PhD, FRACP, Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide Medical School, The University of Adelaide, Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia. ; Level 5, Adelaide Health and Medical Science building, North Terrace, Adelaide SA 5000, Australia
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Jalleh RJ, Rayner CK, Jones KL, Horowitz M. Glucagon-like peptide-1 receptor agonists, weight loss, and gastric emptying: have I gut news for you. Obesity (Silver Spring) 2022; 30:1533-1534. [PMID: 35894084 PMCID: PMC9544962 DOI: 10.1002/oby.23525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Ryan J. Jalleh
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
- Diabetes and Endocrine ServicesNorthern Adelaide Local Health NetworkAdelaideAustralia
| | - Christopher K. Rayner
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Department of Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideAustralia
| | - Karen L. Jones
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | - Michael Horowitz
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
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Stevens JE, Jalleh RJ, Trahair LG, Marathe CS, Horowitz M, Jones KL. Comparative effects of low-carbohydrate, full-strength and low-alcohol beer on gastric emptying, alcohol absorption, glycaemia and insulinaemia in health. Br J Clin Pharmacol 2022; 88:3421-3427. [PMID: 35246999 PMCID: PMC9314679 DOI: 10.1111/bcp.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS The aim of this study was to evaluate the comparative effects of low-carbohydrate (LC), full-strength (FS), and low-alcohol (LA) beer on gastric emptying (GE), ethanol absorption, glycaemia and insulinaemia in health. METHODS Eight subjects (four male, four female; age: 20.4 ± 0.4 years; BMI 22.7 ± 0.4 kg/m2 ) had concurrent measurements of GE, plasma ethanol, blood glucose and plasma insulin for 180 min on three separate occasions after ingesting 600 mL of (i) FS beer (5.0% w/v, 246 kcal, 19.2 g carbohydrate), (ii) LC beer (4.6% w/v, 180 kcal, 5.4 g carbohydrate) and (iii) LA beer (2.6% w/v, 162 kcal, 17.4 g carbohydrate) labelled with 20 MBq 99mTc-calcium phytate, in random order. RESULTS There was no difference in the gastric 50% emptying time (T50) (FS: 89.0 ± 13.5 min vs LC: 79.5 ± 12.9 min vs LA: 74.6 ± 12.4 min; P = .39). Plasma ethanol was less after LA than LC (P < .001) and FS (P < .001), with no difference between LC and FS (P = 1.0). There was an inverse relationship between plasma ethanol at 15 min and GE after LA (r = -0.87, P < .01) and a trend for inverse relationships after LC (r = -0.67, P = .07) and FS (r = -0.69, P = .06). The AUC 0-180 min for blood glucose was greater for LA than LC (P < .001), with no difference between LA and FS (P = .40) or LC and FS (P = 1.0). CONCLUSION In healthy young subjects, GE of FS, LC and LA beer is comparable and a determinant of the plasma ethanol response.
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Affiliation(s)
- Julie E. Stevens
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraAustralia
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Clinical and Health SciencesUniversity of South AustraliaAdelaideAustralia
| | - Ryan J. Jalleh
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | | | - Chinmay S. Marathe
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | - Michael Horowitz
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
| | - Karen L. Jones
- Adelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Centre of Research Excellence in Translating Nutritional Science to Good HealthThe University of AdelaideAdelaideAustralia
- Clinical and Health SciencesUniversity of South AustraliaAdelaideAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideAustralia
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Jalleh RJ, Marathe CS, Jones KL, Horowitz M, Rayner CK. Digesting the pathogenesis of diabetic gastroparesis. J Diabetes Complications 2021; 35:107992. [PMID: 34389236 DOI: 10.1016/j.jdiacomp.2021.107992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023]
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