Current Diabetes Reports

, Volume 3, Issue 5, pp 418–426 | Cite as

Nutrition therapy for diabetic gastroparesis

  • Diana Gentilcore
  • Deirdre O'Donovan
  • Karen L. Jones
  • Michael Horowitz


The management of diabetic gastroparesis often represents a significant clinical challenge in which the maintenance of nutrition is pivotal. Gastric emptying is delayed in 30% to 50% of patients with longstanding type 1 or type 2 diabetes and upper gastrointestinal symptoms also occur frequently. However, there is only a weak association between the presence of symptoms and delayed gastric emptying. Acute changes in blood glucose concentrations affect gastric motility in diabetes; hyperglycemia slows gastric emptying whereas hypoglycemia may accelerate it; blood glucose concentrations may also influence symptoms. It is now recognized that gastric emptying is a major determinant of postprandial glycemia and, therefore, there is considerable interest in the concept of modulating gastric emptying, by dietary or pharmacologic means, to optimize glycemic control in diabetes.


Glycemic Control Gastric Emptying Cisapride Blood Glucose Concentration Gastroparesis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Rundles RW: Diabetic neuropathy. Medicine 1945, 24:11–60.CrossRefGoogle Scholar
  2. 2.
    Horowitz M, Harding PE, Maddox A, et al.: Gastric and oeosphageal emptying in insulin-dependent diabetes mellitus. J Gastroenterol Hepatol 1986, 1:97–113.Google Scholar
  3. 3.
    Keshavarzian A, Iber FL, Vaeth J: Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol 1987, 82:29–35.PubMedGoogle Scholar
  4. 4.
    Ziegler D, Schadewaldt P, Pour Mirza A, et al.: [13C]octanoic acid breath test for non-invasive assessment of gastric emptying in diabetic patients: validation and relationship to gastric symptoms and cardiovascular autonomic function. Diabetologia 1996, 39:823–830.PubMedCrossRefGoogle Scholar
  5. 5.
    Dutta U, Padhy AK, Ahuja V, Sharma MP: Double blind controlled trial of effect of cisapride on gastric emptying in diabetics. Trop Gastroenterol 1999, 20:116–119.PubMedGoogle Scholar
  6. 6.
    Horowitz M, Harding PE, Maddox AF, et al.: Gastric and oesophageal emptying in patients with type 2 (noninsulin-dependent) diabetes mellitus. Diabetologia 1989, 32:151–159.PubMedCrossRefGoogle Scholar
  7. 7.
    Wegener M, Borsch G, Schaffstein J, et al.: Gastrointestinal transit disorders in patients with insulin-treated diabetes mellitus. Dig Dis 1990, 8:23–36.PubMedGoogle Scholar
  8. 8.
    Cotroneo P, Grattagliano A, Rapaccini GL, et al.: Gastric emptying rate and hormonal response in type 2 diabetics. Diabetes Res 1991, 17:99–104.PubMedGoogle Scholar
  9. 9.
    Annese V, Bassotti G, Caruso N, et al.: Gastrointestinal motor dysfunction, symptoms, and neuropathy in noninsulindependent (type 2) diabetes mellitus. J Clin Gastroenterol 1999, 29:171–177.PubMedCrossRefGoogle Scholar
  10. 10.
    Lyrenas EB, Olsson EH, Arvidsson UC, et al.: Prevalence and determinants of solid and liquid gastric emptying in unstable type I diabetes. Relationship to postprandial blood glucose concentrations. Diabetes Care 1997, 20:413–418.PubMedCrossRefGoogle Scholar
  11. 11.
    Reid B, DiLorenzo C, Travis L, et al.: Diabetic gastroparesis due to postprandial antral hypomotility in childhood. Pediatrics 1992, 90:43–46.PubMedGoogle Scholar
  12. 12.
    Cucchiara S, Franzese A, Salvia G, et al.: Gastric emptying delay and gastric electrical derangement in IDDM. Diabetes Care 1998, 21:438–443.PubMedCrossRefGoogle Scholar
  13. 13.
    Scott J, Lloyd-Mostyn RH: Letter: Acute autonomic dysfunction in diabetic ketoacidosis. Lancet 1976, 1:590.PubMedCrossRefGoogle Scholar
  14. 14.
    Horowitz M, Maddox AF, Wishart JM, et al.: Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med 1991, 18:229–234.PubMedCrossRefGoogle Scholar
  15. 15.
    Phillips WT, Schwartz JG, McMahan CA: Rapid gastric emptying of an oral glucose solution in type 2 diabetic patients. J Nucl Med 1992, 33:1496–1500.PubMedGoogle Scholar
  16. 16.
    Jones KL, Horowitz M, Wishart MJ, et al.: Relationships between gastric emptying, intragastric meal distribution and blood glucose concentrations in diabetes mellitus. J Nucl Med 1995, 36:2220–2228.PubMedGoogle Scholar
  17. 17.
    Jones KL, Russo A, Berry MK, et al.: A longitudinal study of gastric emptying and upper gastrointestinal symptoms in patients with diabetes mellitus. Am J Med 2002, 113:449–455.PubMedCrossRefGoogle Scholar
  18. 18.
    Kong MF, Horowitz M, Jones KL, et al.: Natural history of diabetic gastroparesis. Diabetes Care 1999, 22:503–507.PubMedCrossRefGoogle Scholar
  19. 19.
    Horowitz M, Dent J: Disordered gastric emptying: mechanical basis,assessment and treatment. Baillieres Clin Gastroenterol 1991, 5:371–407.PubMedCrossRefGoogle Scholar
  20. 20.
    Hausken T, Odegaard S, Matre K, Berstad A: Antroduodenal motility and movements of luminal contents studied by duplex sonography. Gastroenterology 1992, 102:1583–1590.PubMedGoogle Scholar
  21. 21.
    Horowitz M, Dent J, Fraser R, et al.: Role and integration of mechanisms controlling gastric emptying. Dig Dis Sci 1994, 39:7S-13S.PubMedCrossRefGoogle Scholar
  22. 22.
    Azpiroz F, Malagelada JR: Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology 1987, 92:934–943.PubMedGoogle Scholar
  23. 23.
    Der-Silaphet T, Malysz J, Hagel S, et al.: Interstitial cells of cajal direct normal propulsive contractile activity in the mouse small intestine. Gastroenterology 1998, 114:724–736.PubMedCrossRefGoogle Scholar
  24. 24.
    Horowitz M, O'Donovan D, Jones KL, et al.: Gastric emptying in diabetes: clinical significance and treatment. Diabet Med 2002, 19:177–194. A comprehensive and recent review that details the importance of gastric emptying in diabetes mellitus.PubMedCrossRefGoogle Scholar
  25. 25.
    Collins PJ, Houghton LA, Read NW, et al.: Role of the proximal and distal stomach in mixed solid and liquid meal emptying. Gut 1991, 32:615–619.PubMedGoogle Scholar
  26. 26.
    Horowitz M, Maddox A, Bochner M, et al.: Relationships between gastric emptying of solid and caloric liquid meals and alcohol absorption. Am J Physiol 1989, 257:G291-G298.PubMedGoogle Scholar
  27. 27.
    Lin HC, Doty JE, Reedy TJ, Meyer JH: Inhibition of gastric emptying by glucose depends on length of intestine exposed to nutrient. Am J Physiol 1989, 256:G404-G411.PubMedGoogle Scholar
  28. 28.
    Horowitz M, Edelbroek MA, Wishart JM, Straathof JW: Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects. Diabetologia 1993, 36:857–862.PubMedCrossRefGoogle Scholar
  29. 29.
    Carney BI, Jones KL, Horowitz M, et al.: Gastric emptying of oil and aqueous meal components in pancreatic insufficiency: effects of posture and on appetite. Am J Physiol 1995, 268:G925-G932.PubMedGoogle Scholar
  30. 30.
    Belai A, Calcutt NA, Carrington AL, et al.: Enteric neuropeptides in streptozotocin-diabetic rats; effects of insulin and aldose reductase inhibition. J Auton Nerv Syst 1996, 58:163–169.PubMedCrossRefGoogle Scholar
  31. 31.
    Yoshida MM, Schuffler MD, Sumi SM: There are no morphologic abnormalities of the gastric wall or abdominal vagus in patients with diabetic gastroparesis. Gastroenterology 1988, 94:907–914.PubMedGoogle Scholar
  32. 32.
    He CL, Soffer EE, Ferris CD, et al.: Loss of interstitial cells of cajal and inhibitory innervation in insulin-dependent diabetes. Gastroenterology 2001, 121:427–434. The results of a case study of a patient with long-standing insulindependent diabetes and associated gastroparesis with evidence of neurologic damage.PubMedCrossRefGoogle Scholar
  33. 33.
    Rayner CK, Samsom M, Jones KL, Horowitz M: Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care 2001, 24:371–381. A detailed summary of the interrelationships between gastric emptying and glycemic control, including the effects of blood glucose concentrations on gastrointestinal motor and sensory function.PubMedCrossRefGoogle Scholar
  34. 34.
    Fraser RJ, Horowitz M, Maddox AF, et al.: Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990, 33:675–680.PubMedCrossRefGoogle Scholar
  35. 35.
    Schvarcz E, Palmer M, Aman J, et al.: Hypoglycaemia increases the gastric emptying rate in patients with type 1 diabetes mellitus. Diabet Med 1993, 10:660–663.PubMedCrossRefGoogle Scholar
  36. 36.
    Schvarcz E, Palmer M, Aman J, Berne C: Hypoglycemia increases the gastric emptying rate in healthy subjects. Diabetes Care 1995, 18:674–676.PubMedCrossRefGoogle Scholar
  37. 37.
    Schvarcz E, Palmer M, Aman J, et al.: Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus. Gastroenterology 1997, 113:60–66.PubMedCrossRefGoogle Scholar
  38. 38.
    Jones KL, Russo A, Stevens JE, et al.: Predictors of delayed gastric emptying in diabetes. Diabetes Care 2001, 24:1264–1269.PubMedCrossRefGoogle Scholar
  39. 39.
    Jones KL, Wishart JM, Berry M, et al.: Helicobacter pylori infection is not associated with delayed gastric emptying or upper gastrointestinal symptoms in diabetes mellitus. Dig Dis Sci 2002, 47:704–709.PubMedCrossRefGoogle Scholar
  40. 40.
    Jones KL, Tonkin A, Horowitz M, et al.: Rate of gastric emptying is a determinant of postprandial hypotension in non-insulin-dependent diabetes mellitus. Clin Sci (Lond) 1998, 94:65–70.Google Scholar
  41. 41.
    Bytzer P, Talley NJ, Leemon M, et al.: Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 2001, 161:1989–1996.PubMedCrossRefGoogle Scholar
  42. 42.
    Ricci JA, Siddique R, Stewart WF, et al.: Upper gastrointestinal symptoms in a U.S. national sample of adults with diabetes. Scand J Gastroenterol 2000, 35:152–159.PubMedCrossRefGoogle Scholar
  43. 43.
    Farup CE, Leidy NK, Murray M, et al.: Effect of domperidone on the health-related quality of life of patients with symptoms of diabetic gastroparesis. Diabetes Care 1998, 21:1699–1706.PubMedCrossRefGoogle Scholar
  44. 44.
    Siddique R, Ricci JA, Stewart WF, et al.: Quality of life in a US national sample of adults with diabetes and motility-related upper gastrointestinal symptoms. Dig Dis Sci 2002, 47:683–689.PubMedCrossRefGoogle Scholar
  45. 45.
    Talley SJ, Bytzer P, Hammer J, et al.: Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus. Am J Gastroenterol 2001, 96:1033–1038.PubMedCrossRefGoogle Scholar
  46. 46.
    Kassander P: Asymptomatic gastric retention in diabetics: gastroparesis diabeticorum. Ann Intern Med 1958, 48:797–812.PubMedGoogle Scholar
  47. 47.
    Jones KL, Horowitz M, Carney BI, et al.: Gastric emptying in early noninsulin-dependent diabetes mellitus. J Nucl Med 1996, 37:1643–1648.PubMedGoogle Scholar
  48. 48.
    Jones KL, Horowitz M, Berry M, et al.: Blood glucose concentration influences postprandial fullness in IDDM. Diabetes Care 1997, 20:1141–1146.PubMedCrossRefGoogle Scholar
  49. 49.
    Hebbard GS, Sun WM, Bochner F, Horowitz M: Pharmacokinetic considerations in gastrointestinal motor disorders. Clin Pharmacokinet 1995, 28:41–66.PubMedGoogle Scholar
  50. 50.
    Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group [no authors listed]. Lancet 1998, 352:837–853.Google Scholar
  51. 51.
    The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group [no authors listed]. N Engl J Med 1993, 329:977–986.Google Scholar
  52. 52.
    Bastyr EJ 3rd, Stuart CA, Brodows RG, et al.: Therapy focused on lowering postprandial glucose, not fasting glucose, may be superior for lowering HbA1c. IOEZ Study Group. Diabetes Care 2000, 23:1236–1241.PubMedCrossRefGoogle Scholar
  53. 53.
    Sievenpiper JL, Jenkins DJ, Josse RG, Vuksan V: Dilution of the 75-g oral glucose tolerance test increases postprandial glycemia: implications for diagnostic criteria. CMAJ 2000, 162:993–996.PubMedGoogle Scholar
  54. 54.
    Berry MK, Russo A, Wishart JM, et al.: Effect of solid meal on gastric emptying of, and glycemic and cardiovascular responses to liquid glucose in older subjects. Am J Physiol Gastrointest Liver Physiol 2003, 284:G655-G662.PubMedGoogle Scholar
  55. 55.
    Schwartz JG, Guan D, Green GM, Phillips WT: Treatment with an oral proteinase inhibitor slows gastric emptying and acutely reduces glucose and insulin levels after a liquid meal in type 2 diabetic patients. Diabetes Care 1994, 17:255–262.PubMedCrossRefGoogle Scholar
  56. 56.
    Ishii M, Nakamura T, Kasai F, et al.: Altered postprandial insulin requirement in IDDM patients with gastroparesis. Diabetes Care 1994, 17:901–903.PubMedCrossRefGoogle Scholar
  57. 57.
    Pilichiewicz A, O'Donovan D, Feinle C, et al.: Effect of lipase inhibition on gastric emptying of, and the glycaemic and incretin responses to an oil/aqueous drink in type 2 diabetes mellitus. J Clin Endocrinol Metab 2003, in press.Google Scholar
  58. 58.
    Chandalia M, Garg A, Lutjohann D, et al.: Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med 2000, 342:1392–1398.PubMedCrossRefGoogle Scholar
  59. 59.
    Darwiche G, Ostman EM, Liljeberg HG, et al.: Measurements of the gastric emptying rate by use of ultrasonography: studies in humans using bread with added sodium propionate. Am J Clin Nutr 2001, 74:254–258.PubMedGoogle Scholar
  60. 60.
    Welch IM, Bruce C, Hill SE, Read NW: Duodenal and ileal lipid suppresses postprandial blood glucose and insulin responses in man: possible implications for the dietary management of diabetes mellitus. Clin Sci (Lond) 1987, 72:209–216.Google Scholar
  61. 61.
    Cox JE, Tyler WJ, Randich A, et al.: Suppression of food intake, body weight, and body fat by jejunal fatty acid infusions. Am J Physiol Regul Integr Comp Physiol 2000, 278:R604-R610.PubMedGoogle Scholar
  62. 62.
    Stacher G, Schernthaner G, Francesconi M, et al.: Cisapride versus placebo for 8 weeks on glycemic control and gastric emptying in insulin-dependent diabetes: a double blind cross-over trial. J Clin Endocrinol Metab 1999, 84:2357–2362.PubMedCrossRefGoogle Scholar
  63. 63.
    Ueno N, Inui A, Asakawa A, et al.: Erythromycin improves glycaemic control in patients with type 2 diabetes mellitus. Diabetologia 2000, 43:411–415.PubMedCrossRefGoogle Scholar
  64. 64.
    Samsom M, Szarka LA, Camilleri M, et al.: Pramlintide, an amylin analog, selectively delays gastric emptying: potential role of vagal inhibition. Am J Physiol Gastrointest Liver Physiol 2000, 278:G946-G951.PubMedGoogle Scholar
  65. 65.
    Baron AD, Kim D, Weyer C: Novel peptides under development for the treatment of type 1 and type 2 diabetes mellitus. Curr Drug Targets Immune Endocr Metabol Disord 2002, 2:63–82.PubMedCrossRefGoogle Scholar
  66. 66.
    Nauck MA, Holst JJ, Willms B, Schmiegel W: Glucagon-like peptide 1 (GLP-1) as a new therapeutic approach for type 2-diabetes. Exp Clin Endocrinol Diabetes 1997, 105:187–195.PubMedCrossRefGoogle Scholar
  67. 67.
    Willms B, Werner J, Holst JJ, et al.: Gastric emptying, glucose responses, and insulin secretion after a liquid test meal: effects of exogenous glucagon-like peptide-1 (GLP-1)-(7-36) amide in type 2 (noninsulin-dependent) diabetic patients. J Clin Endocrinol Metab 1996, 81:327–332.PubMedCrossRefGoogle Scholar
  68. 68.
    Zander M, Madsbad S, Madsen JL, Holst JJ: Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and beta-cell function in type 2 diabetes: a parallel-group study. Lancet 2002, 359:824–830.PubMedCrossRefGoogle Scholar
  69. 69.
    Buse JB, Fineman MS, Gottlieb A, et al.: Effects of five-day dosing of synthetic exendin-4 (AC2993) in people with type 2 diabetes [abstract]. Diabetes 2000, 49(suppl):A100.Google Scholar
  70. 70.
    Egan JM, Clocquet AR, Elahi D: The insulinotropic effect of acute exendin-4 administered to humans: comparison of nondiabetic state to type 2 diabetes. J Clin Endocrinol Metab 2002, 87:1282–1290. A study investigating the use of intravenous exendin-4, an agonist of GLP-1, as a long-lasting insulin stimulant in nondiabetic and type 2 diabetic patients.PubMedCrossRefGoogle Scholar
  71. 71.
    Enc FY, Imeryuz N, Akin L, et al.: Inhibition of gastric emptying by acarbose is correlated with GLP-1 response and accompanied by CCK release. Am J Physiol Gastrointest Liver Physiol 2001, 281:G752-G763.PubMedGoogle Scholar
  72. 72.
    Samsom M, Smout AJ, Goozen HG: Medical and surgical treatment of gastroparesis. Gastroenterol Int 1998, 11:169–176.Google Scholar
  73. 73.
    Janssens J, Peeters TL, Vantrappen G, et al.: Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. N Engl J Med 1990, 322:1028–1031.PubMedCrossRefGoogle Scholar
  74. 74.
    Jones KL, Berry M, Kong MF, et al.: Hyperglycemia attenuates the gastrokinetic effect of erythromycin and affects the perception of postprandial hunger in normal subjects. Diabetes Care 1999, 22:339–344.PubMedCrossRefGoogle Scholar
  75. 75.
    Petrakis IE, Chalkiadakis G, Vrachassotakis N, et al.: Induced-hyperglycemia attenuates erythromycin-induced acceleration of hypertonic liquid-phase gastric emptying in type 1 diabetic patients. Dig Dis 1999, 17:241–247.PubMedCrossRefGoogle Scholar
  76. 76.
    Tonini M, De Ponti F, Di Nucci A, Crema F: Review article: cardiac adverse effects of gastrointestinal prokinetics. Aliment Pharmacol Ther 1999, 13:1585–1591.PubMedCrossRefGoogle Scholar
  77. 77.
    McHugh S, Lico S, Diamant NE: Cisapride vs metoclopramide. An acute study in diabetic gastroparesis. Dig Dis Sci 1992, 37:997–1001.PubMedCrossRefGoogle Scholar
  78. 78.
    Jones KL, Wishart JM, Berry MK, et al.: Effects of fedotozine on gastric emptying and upper gastrointestinal symptoms in diabetic gastroparesis. Aliment Pharmacol Ther 2000, 14:937–943.PubMedCrossRefGoogle Scholar
  79. 79.
    Ezzeddine D, Jit R, Katz N, et al.: Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis. Gastrointest Endosc 2002, 55:920–923.PubMedCrossRefGoogle Scholar
  80. 80.
    McCallum RW, Chen JD, Lin Z, et al.: Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology 1998, 114:456–461.PubMedCrossRefGoogle Scholar
  81. 81.
    Hathaway DK, Abell T, Cardoso S, et al.: Improvement in autonomic and gastric function following pancreas-kidney versus kidney-alone transplantation and the correlation with quality of life. Transplantation 1994, 57:816–822.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Diana Gentilcore
  • Deirdre O'Donovan
  • Karen L. Jones
  • Michael Horowitz
    • 1
  1. 1.Department of MedicineRoyal Adelaide HospitalAdelaideAustralia

Personalised recommendations