Postprandial Blood Glucose Control and Gastric Emptying in Type 1 Diabetes: Pathogenetic Factors and Therapeutic Options
Postprandial Blood Glucose Control and Gastric Emptying in Type 1 Diabetes: Pathogenetic Factors and Therapeutic Options
This study evaluates the prevalence of gastric emptying (GE) in type 1 diabetic patients
 (DM1) free of chronic complications in comparison with a group of healthy control subjects.
 The investigators will also assess the relationship between GE and glucose control (HbA1c,
 postprandial glucose variability), gut peptide hormones (GLP-1, GIP, and ghrelin), and
 gastrointestinal symptoms.

 In addition, in patients with delayed GE the investigators will investigate the effect of
 "tailored" pre-prandial insulin bolus administered by means of insulin pump in reducing
 postprandial glucose variability, evaluated through continuous glucose monitoring system.
Diabetic patients with a delayed GE will be studied in 2 separate occasions in euglycemic
 condition and under CGM. On both occasions, they will have to take a standard meal poor of
 lipids (rice 60 g; yellow squash 200 g; extra virgin olive oil 7 g; adult veal lean cuts 90
 g; bananas 180 g; ordinary bread 75 g).

 On the first occasion pre-prandial insulin will be administered as single bolus calculated on
 the basis of carbohydrate counting and each patient's insulin/glycaemic load.

 On the second occasion the amount of pre-prandial insulin will be the same as the first one
 test but fractioned into a double-wave bolus. The "tailored" insulin bolus will be defined
 according to the individual pattern of GE, as follows:

 -  GE T1/2 121-180 min= 60% as bolus + 40% during following 2 h

 -  GE T1/2 >180 min= 40% as bolus + 60% during following 4 h Glycemic variability will be
 assessed by the means of Continuous Glucose Monitoring System and the following indexes
 of glucose variability will be calculated: number of hypoglycemic events, number of
 hyperglycemic events, standard deviation of glycemia, glycemia variation coefficient,
 mean range of daily glycemia, interquartile range, M value, mean amplitude of glycemic
 excursions (MAGE), low blood glucose index (LBGI), high blood glucose index (HBGI).
Inclusion Criteria:

 -  DM1;

 -  Use of insulin pump;

 -  Disease duration ≥ 3 years.

 Exclusion Criteria:

 -  Presence of chronic complications of DM (including cardiovascular autonomic
 neuropathy);

 -  BMI ≥ 30 kg/m2;

 -  Presence of chronic diseases other than DM1;

 -  Diseases that interfere with GE;

 -  Medications that interfere with blood glucose homeostasis (except insulin) and GE.