Gastric emptying and glycaemia in health and diabetes mellitus
Abstract
The rate of gastric emptying is a critical determinant of postprandial glycaemia and, accordingly, is fundamental to maintaining blood glucose homeostasis. Disordered gastric emptying occurs frequently in patients with longstanding type 1 diabetes mellitus and type 2 diabetes mellitus (T2DM). A complex bidirectional relationship exists between gastric emptying and glycaemia--gastric emptying accounts for ∼35% of the variance in peak postprandial blood glucose concentrations in healthy individuals and in patients with diabetes mellitus, and the rate of emptying is itself modulated by acute changes in glycaemia. Clinical implementation of incretin-based therapies for the management of T2DM, which diminish postprandial glycaemia, in part by slowing gastric emptying, is widespread. Other therapies for patients with T2DM, which specifically target gastric emptying include pramlintide and dietary-based treatment approaches. A weak association exists between upper gastrointestinal symptoms and the rate of gastric emptying. In patients with severe diabetic gastroparesis, pathological changes are highly variable and are characterized by loss of interstitial cells of Cajal and an immune infiltrate. Management options for patients with symptomatic gastroparesis remain limited in their efficacy, which probably reflects the heterogeneous nature of the underlying pathophysiology.
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Even minimal fluctuations in gastric motility can produce substantial differences in the timing and magnitude of postprandial hyperglycemia.
“Even minimal fluctuations in gastric motility can therefore produce substantial differences in the timing and magnitude of postprandial hyperglycemia [92, 93].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [93]
The key determinants of the postprandial blood glucose response are the amount, rate and extent of carbohydrate digestion, insulin secretory response, and gastric emptying.
“The key determinants of the postprandial blood glucose response are the amount, rate and extent of carbohydrate digestion [4], insulin secretory response [5] and gastric emptying [6,7].”
From Effect of Cold Storage and Reheating of Parboiled Rice on Postprandial Glycaemic Response, Satiety, Palatability and Chewed Particle Size Distribution (2017) · cites this paper as [6]
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- Authors
- Phillips, L. K., Deane, A. M., Jones, K. L., Rayner, C. K., & Horowitz, M.
- Affiliations
- Royal Adelaide Hospital (AU)
- Corresponding author
- Horowitz, Michael
- Venue
- Nature Reviews Endocrinology
- Published
- 2014-11-25
- Volume
- 11
- Issue
- 2
- Pages
- 112-128
- ISSN
- 1759-5029 (ISSN-L)
- 1759-5037
- OpenAlex
- W1972975385
- Cited by
- 273
- References
- 24
- Citations by year
- 2026: 14 · 2025: 21 · 2024: 26 · 2023: 20 · 2022: 27 · 2021: 31 · 2020: 29 · 2019: 30 · 2018: 26 · 2017: 20 · 2016: 15 · 2015: 14
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetic gastroparesis, gastric emptying, postprandial glycaemia, type 1 diabetes, type 2 diabetes, incretin-based therapy, pramlintide, interstitial cells of Cajal, immune cell infiltration, blood glucose homeostasis
- MeSH terms
- Gastric Emptying, Humans, Hyperglycemia, Hypoglycemic Agents, Postprandial Period
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