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Neurogastroenterol Motil. 2016 Jul;28(7):1001-15. doi: 10.1111/nmo.12800. Epub 2016 Mar 6.

Baseline features and differences in 48 week clinical outcomes in patients with gastroparesis and type 1 vs type 2 diabetes.

Author information

1
Section on Gastroenterology, Wake Forest University, Winston-Salem, NC, USA.
2
Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA.
3
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
4
Section of Gastroenterology, Temple University, Philadelphia, PA, USA.
5
Center for Neurogastroenterology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
6
Endocrinology Section, MetroHealth Medical Center, Cleveland, OH, USA.
7
California Pacific Medical Center, San Francisco, CA, USA.
8
Digestive and Liver Health, University of Louisville, Louisville, KY, USA.
9
Division of Gastroenterology, Texas Tech University, El Paso, TX, USA.
10
Division of Gastroenterology, Stanford University, Palo Alto, CA, USA.
11
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
12
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.

Abstract

BACKGROUND:

In studies of diabetic gastroparesis, patients with type 1 and type 2 diabetes mellitus (T1DM, T2DM) are often combined for analyses. We compared gastroparesis severity, healthcare utilization, psychological function, and quality of life in T1DM vs T2DM gastroparesis patients.

METHODS:

Questionnaire, laboratory, and scintigraphy data from patients with gastroparesis and T1DM and T2DM from seven centers of the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Registry were compared at enrollment and after 48 weeks. Multiple regression models assessed baseline and follow-up differences between diabetes subtypes.

KEY RESULTS:

At baseline, T1DM patients (N = 78) had slower gastric emptying, more hospitalizations, more gastric stimulator implantations, higher hemoglobin A1c (HbA1c), and more anxiety vs T2DM patients (N = 59). Independent discriminators of patients with T1DM vs T2DM included worse gastroesophageal reflux disease, less bloating, more peripheral neuropathy, and fewer comorbidities (p ≤ 0.05). On follow-up, gastrointestinal (GI) symptom scores decreased only in T2DM (p < 0.05), but not in T1DM patients who reported greater prokinetic, proton pump inhibitor, anxiolytic, and gastric stimulator usage over 48 weeks (p ≤ 0.03). Gastrointestinal symptoms at baseline and 48 weeks with both subtypes were not associated with HbA1c, peripheral neuropathy, psychological factors, or quality of life.

CONCLUSIONS & INFERENCES:

Baseline symptoms were similar in T1DM and T2DM patients, even though T1DM patients had worse gastric emptying delays and higher HbA1c suggesting other factors mediate symptom severity. Symptom scores at 48 weeks decreased in T2DM, but not T1DM patients, despite increased medical and surgical treatment utilization by T1DM patients. Defining causes of different outcomes in diabetic gastroparesis warrants further investigation.

KEYWORDS:

gastric emptying; gastroparesis; hyperglycemia; nausea and vomiting; type 1 and type 2 diabetes mellitus

PMID:
26946489
PMCID:
PMC5319426
DOI:
10.1111/nmo.12800
[Indexed for MEDLINE]
Free PMC Article

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