<b>Objective:</b> Acute experimental
variations in glycemia decelerate (hyperglycemia) or accelerate (hypoglycemia)
gastric emptying. Whether spontaneous
variations in fasting plasma glucose (FPG) have a similar influence on gastric
emptying is yet unclear.
<p><b>Research design and methods:</b> Gastric emptying of a mixed meal was
prospectively studied three times in 20 patients with type 1 diabetes and 10
healthy subjects with normal glucose tolerance using a <sup>13</sup>C-CO<sub>2</sub>
octanoate breath test with Wagner-Nelson analysis. The velocity of gastric emptying
was related to fasting plasma glucose (FPG) measured before the test (grouped as
low, intermediate, or high). In addition, gastric emptying data from 255
patients with type 1 diabetes studied for clinical indications were compared by
tertiles of baseline FPG. </p>
<p><b>Results:</b> Despite marked variations in FPG (by 4.8 (3.4;
6.2) mmol/l), gastric emptying did not differ between the three prospective
examinations in patients with type 1 diabetes (D T<sub>1/2</sub> between highest and lowest
FPG: 1 [95 % CI: -35; 37] min; p = 0.90). The coefficient of variation for T<sub>1/2
</sub>determined three times was 21.0 %. Similar results at much lower
variations in FPG were found in healthy subjects. In the cross-sectional
analysis, gastric emptying did not differ between the tertiles of FPG (D T<sub>1/2</sub> between highest and lowest
FPG: 7 [95 % CI: - 10; 23] min; p = 0.66), when FPG varied by 7.2 (6.7; 7.8)
mmol/l. However, higher HbA<sub>1c</sub> was significantly related to slower gastric
emptying.</p>
<p><b>Conclusions:</b> Day-to-day variations in FPG not induced by
therapeutic measures do not influence gastric emptying significantly. These
findings are in contrast with those obtained after rapidly clamping plasma
glucose in the hyper- or hypoglycemic concentrations range and challenge the clinical
importance of short-term glucose fluctuations for gastric emptying in type
1-diabetic patients. Rather, chronic hyperglycemia is associated with slowed
gastric emptying.</p>
Effects of insulin degludec and insulin glargine on day-to-day fasting plasma glucose variability in individuals with type 1 diabetes: a multicentre, randomised, crossover study
