Accurate Measurements of Gastric Emptying and Gastrointestinal Symptoms in the Evaluation of Glucagon-like Peptide-1 Receptor Agonists

Ideas and Opinions7 November 2023Accurate Measurements of Gastric Emptying and Gastrointestinal Symptoms in the Evaluation of Glucagon-like Peptide-1 Receptor AgonistsRyan J. Jalleh, MBBS, Karen L. Jones, Dip App Sc (Nuclear Medicine), PhD, Michael Nauck, MD, and Michael Horowitz, MBBS, PhD, DScRyan J. Jalleh, MBBSCentre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South Australia, Australia (R.J.J., K.L.J., M.H.)Search for more papers by this author, Karen L. Jones, Dip App Sc (Nuclear Medicine), PhDCentre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South Australia, Australia (R.J.J., K.L.J., M.H.)Search for more papers by this author, Michael Nauck, MDDiabetes Endocrinology, Metabolism Section, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University, Bochum, Germany (M.N.).Search for more papers by this author, and Michael Horowitz, MBBS, PhD, DScCentre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South Australia, Australia (R.J.J., K.L.J., M.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-2019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The advent of glucagon-like peptide 1 (GLP-1) receptor agonists (RAs) and, recently, a GLP-1/glucose-dependent insulinotropic polypeptide (GIP) coagonist (tirzepatide), represents a paradigm shift in the management of type 2 diabetes and obesity. The use of these medications is likely to increase: An oral formulation of semaglutide is available, and small-molecule GLP-1 RAs (for example, orforglipron), as well as GLP-1/GIP/glucagon triple agonists (for example, retatrutide) are in late development. The impacts of GLP-1 RAs on glycemic control and body weight are variable, usually for uncertain reasons. Importantly, there is a lack of reliable information relating to their effects to slow gastric ...References1. Umapathysivam MM, Lee MY, Jones KL, et al. Comparative effects of prolonged and intermittent stimulation of the glucagon-like peptide 1 receptor on gastric emptying and glycemia. Diabetes. 2014;63:785-790. [PMID: 24089511] doi:10.2337/db13-0893 CrossrefMedlineGoogle Scholar2. Halawi H, Khemani D, Eckert D, et al. Effects of liraglutide on weight, satiation, and gastric functions in obesity: a randomised, placebo-controlled pilot trial. Lancet Gastroenterol Hepatol. 2017;2:890-899. [PMID: 28958851] doi:10.1016/S2468-1253(17)30285-6 CrossrefMedlineGoogle Scholar3. Jones KL, Huynh LQ, Hatzinikolas S, et al. Exenatide once weekly slows gastric emptying of solids and liquids in healthy, overweight people at steady-state concentrations. Diabetes Obes Metab. 2020;22:788-797. [PMID: 31903712] doi:10.1111/dom.13956 CrossrefMedlineGoogle Scholar4. Jensterle M, Ferjan S, Lezaic L, et al. Semaglutide delays 4-hour gastric emptying in women with polycystic ovary syndrome and obesity. Diabetes Obes Metab. 2023;25:975-984. [PMID: 36511825] doi:10.1111/dom.14944 CrossrefMedlineGoogle Scholar5. Linnebjerg H, Park S, Kothare PA, et al. Effect of exenatide on gastric emptying and relationship to postprandial glycemia in type 2 diabetes. Regul Pept. 2008;151:123-129. [PMID: 18675854] doi:10.1016/j.regpep.2008.07.003 CrossrefMedlineGoogle Scholar6. Jalleh RJ, Jones KL, Rayner CK, et al. Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control. Diabetologia. 2022;65:1981-1993. [PMID: 36194250] doi:10.1007/s00125-022-05796-1 CrossrefMedlineGoogle Scholar7. Trahair LG, Nauck MA, Wu T, et al. Measurement of gastric emptying using a 13C-octanoic acid breath test with Wagner-Nelson analysis and scintigraphy in type 2 diabetes. Exp Clin Endocrinol Diabetes. 2022;130:751-757. [PMID: 35231948] doi:10.1055/a-1784-6185 CrossrefMedlineGoogle Scholar8. Du YT, Rayner CK, Jones KL, et al. Gastrointestinal symptoms in diabetes: prevalence, assessment, pathogenesis, and management. Diabetes Care. 2018;41:627-637. [PMID: 29463666] doi:10.2337/dc17-1536 CrossrefMedlineGoogle Scholar9. American Society of Anesthesiologists. American Society of Anesthesiologists consensus-based guidance on preoperative management of patients (adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. 29 June 2023. Accessed at www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative on18 Jul 2023. Google Scholar10. Acosta A, Camilleri M, Abu Dayyeh B, et al. Selection of antiobesity medications based on phenotypes enhances weight loss: a pragmatic trial in an obesity clinic. Obesity (Silver Spring). 2021;29:662-671. [PMID: 33759389] doi:10.1002/oby.23120 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Ryan J. Jalleh, MBBS; Karen L. Jones, Dip App Sc (Nuclear Medicine), PhD; Michael Nauck, MD; Michael Horowitz, MBBS, PhD, DScAffiliations: Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, South Australia, Australia (R.J.J., K.L.J., M.H.)Diabetes Endocrinology, Metabolism Section, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University, Bochum, Germany (M.N.).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2019.Corresponding author: Prof Michael Horowitz, University of Adelaide, Level 5 AHMS Building, 4 North Terrace, Adelaide, SA 5000, Australia; e-mail, michael.horowitz@adelaide.edu.au.Author Contributions: Conception and design: M. Horowitz, R. Jalleh, K.L. Jones, M.A. Nauck.Analysis and interpretation of the data: M. Horowitz, R. Jalleh, M.A. Nauck.Drafting of the article: M. Horowitz, R. Jalleh, K.L. Jones.Critical revision for important intellectual content: M. Horowitz, R. Jalleh, K.L. Jones, M.A. Nauck.Final approval of the article: M. Horowitz, R. Jalleh, K.L. Jones, M.A. Nauck.Administrative, technical, or logistic support: R. Jalleh.Collection and assembly of data: R. Jalleh, M.A. Nauck.This article was published at Annals.org on 7 November 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics LatestKeywordsDiabetes mellitus ePublished: 7 November 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...