Diabetic and Gastric Emptying

Thesis proposal: Diabetic and Gastric Emptying
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Introduction
Even though, there is controversy on the rates prevalence of gastric empty disorders among diabetic patients, there are suggestions that diabetes accelerates the problem of gastric emptying. Nonetheless, changes in blood glucose levels have been found to influence gastric emptying because the glucose concentration also affects gastric motor functioning. Gastric emptying is typically faster for patients with hypoglycaemia and vice versa, showing that blood glucose concentration is one of the factors to be take in into account when highlighting on delayed gastric emptying (Horowitz et al., 2002 p. 179). Hence, more robust studies focusing on factors that cause delayed gastric emptying are necessary for identifying the most effective treatments among diabetic patients.
Justification/ background of the problem
Past research show that there is delayed gastric emptying for both type 1 and 2 diabetes, whereby for patients who require insulin are more likely to have symptoms of delayed gastric emptying (Chang et al., 2012, 2595). It is likely that there is delay in absorption of nutrients in the small intestines that may result to delay gastric emptying, and hence there is a mismatch between blood glucose levels and insulin peaks (Lysy et al, 2006, p. 434). Glycaemia control becomes more difficult like blood glucose regulation, and hypoglycaemia may also result to a mismatch between insulin peak and food absorption. (Lysy et al, 2006, p. 435). Past researches using animal models have highlighted the need to understand the way gastrointestinal motility affects glycemic control, and it is through more research that it will be possible to establish the link between the two factors in humans (Rayber & Horowitz., 2006, p. 300).
In order to limit diabetes and gastrointestinal complications, there is a need to achieve better metabolic control, since the problem of gastric emptying may result to impaired drug absorption (Olausson et al., 2013 p. e225). In any case, both pharmacological and dietary approaches have been suggested to improve glycemic control for diabetic patients with gastric emptying problems (Phillips et al., 2014). Even though, delayed gastric emptying is the most common, diabetic patients may also suffer rapid gastric emptying, with duration of diabetes (Bharucha et al., 2009, p. 418).
It is easier to test and assess gastric empting of solids than liquids, with gastric emptying scintigraphy being the most common approach (Sachdeva 2011, p. 1143). The onset of upper abdominal pain as well as abdominal fullness and bloating are associated with delayed gastric emptying in patents with diabetes (Sachdeva 2011, p. 1143). Diabetic patients with delayed gastric emptying, and have poor quality of life and impaired drug absorption and this may increase complications (Ma et al., 2009 a, p. 976). Nonetheless, there is controversy on the long-term association between diabetes and gastric empting since gastric emptying is stable over time (Chang et al., 2012, p. 2595).
Intervention: nutrition
According to Ma et al (2009, p. 1601), a preload of whey protein together with a high carbohydrate meal may result to better glycemic control among diabetic patients. Hence, there is a need for more attention on the role of nutrition in managing diabetes and gastrointestinal complications. Various studies show different prevalence rates of gastric emptying the role of caloric density is an important factor that may result to these differences from region to region (Darwiche et al., 2014, p. 102). In comparing the results of studies, accounting for the calorie intake makes it easier to validate results on delayed gastric empting among diabetics. Patients with symptomatic gastropathy are recommended to take small frequent meals low in fibre, and when combined with monitoring of calorie intake it is possible for patients to improve their gastric emptying (Bernstein, 2000).
Significance of the study
Diabetic patients tend to have slower gastric emptying in comparison to non-diabetic individuals. At the same time, gastric emptying is also slower in women compared to men, while gastrointestinal complications are common for both type 1 and II diabetes (Samson et al., 2003, p. 3119). For patients with type1 diabetes, blood glucose concentration is one of the factors affecting gastric emptying, and the duration of diabetes is also a contributing factor (Kojecky et al., 2008, p. 1565). The symptoms of delayed gastric empting are manifested through metabolic instability and or gastrointestinal symptoms (De Block et al., 2002, p. 914). According to Khayyam et al (2010, p. 543), diabetic patients with delayed gastric emptying are more likely to suffer from bloating, stomach fullness and abdominal pain, in comparison to patients with normal gastric emptying.
Implicatio...