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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2023; 14(5): 447-459
Published online May 15, 2023. doi: 10.4239/wjd.v14.i5.447
Inter-relationships between gastric emptying and glycaemia: Implications for clinical practice
Tejaswini Arunachala Murthy, Marianne Chapman, Karen L Jones, Michael Horowitz, Chinmay S Marathe
Tejaswini Arunachala Murthy, Marianne Chapman, Karen L Jones, Michael Horowitz, Chinmay S Marathe, Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
Tejaswini Arunachala Murthy, Marianne Chapman, Intensive Care Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
Marianne Chapman, Karen L Jones, Michael Horowitz, Chinmay S Marathe, NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
Michael Horowitz, Chinmay S Marathe, Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
Author contributions: Arunachala Murthy T and Marathe CS contributed equally to this work; Arunachala Murthy T and Marathe CS designed the review and wrote the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tejaswini Arunachala Murthy, DA, MBBS, Doctor, Lecturer, Researcher, Adelaide Medical School, University of Adelaide, North Terrace, Adelaide 5000, SA, Australia. drpadminimurthy@gmail.com
Received: September 24, 2022
Peer-review started: September 24, 2022
First decision: November 27, 2022
Revised: December 9, 2022
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 15, 2023
Processing time: 233 Days and 6.5 Hours
Abstract

Gastric emptying (GE) exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes; the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired. Conversely, GE is influenced by the acute glycaemic environment acute hyperglycaemia slows, while acute hypoglycaemia accelerates it. Delayed GE (gastroparesis) occurs frequently in diabetes and critical illness. In diabetes, this poses challenges for management, particularly in hospitalised individuals and/or those using insulin. In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence. Substantial advances in knowledge relating to GE, which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and, the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists, which may profoundly impact GE, in the management of type 2 diabetes, has become commonplace. This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia, its implications in hospitalised patients and the relevance of dysglycaemia and its management, particularly in critical illness. Current approaches to management of gastroparesis to achieve more personalised diabetes care, relevant to clinical practice, is detailed. Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients, are required.

Keywords: Glycaemia; Gastric emptying; Clinical practice; Glucagon-like peptide-1

Core Tip: Gastric emptying (GE) is a major determinant of postprandial glycaemia in health, diabetes and critical illness. Acute hyperglycaemia slows GE while insulin-induced hypoglycaemia accelerates it. Gastroparesis occurs frequently in diabetes and critical illness with a weak correlation between gastrointestinal symptoms and GE. Accordingly, diagnosis of gastroparesis should ideally be made after measuring GE with an optimal technique. Glucagon-like peptide-1 receptor agonists, commonly used in the treatment of type 2 diabetes and increasingly in obesity, may profoundly impact GE. We explore the rationale for current glycaemic targets and the implications of dysglycaemia and its management in hospitalised and critically ill populations.