Relationships between diabetic gastroparesis and risk of developing hypoglycemic conditions

I.O. Kostitska, B.M. Mankovsky

Abstract


Background. The purpose of the research was to study the motor-evacuation function of the stomach in order to determine the risk of developing hypoglycemic conditions in patients with type 2 diabetes mellitus. Materials and methods. The study included 112 (62 males and 50 females) patients at the age of 35–76 years with type 2 diabetes mellitus. Depending on antihyperglycemic therapy, there were 4 groups: group I — sulfonylureas + metformin; group II — sulfonylureas + metformin + dipeptidyl peptidase 4 inhibitor/glucagon-like peptide-1 analogue/sodium-glucose linked transporter-2 inhibitor/alpha-glucosidase inhibitors; group III — insulin therapy; group IV — insulin therapy + sulfonylureas + metformin/insulin therapy + metformin. To evaluate the motor function of the stomach, the PAGI-SYM (The Patient Assessment of Gastrointestinal Disorders Symptom Severity Index) and GCSI (Gastroparesis Cardinal Symptom Index) questionnaires as well as the 13C-octanoate breath test were used. The incidence and the severity of low blood sugar symptoms were assessed using the scales of the Hypoglycemia Fear Survey. Results. The results of the PAGI-SYM and GCSI questionnaires as well as the 13C-octanoate breath test indicated a uniform distribution of patients with slowing down of the motor-evacuation function of the stomach. When comparing patients with symptoms of bradygastria and those without them, hypoglycemic conditions were observed by 2.2–3.5 times more often in patients with the signs of diabetic gastroparesis. There was a correlation between the total score of the Hypoglycemia Fear Survey and the results of the 13C-octanoate breath test (r = 0.54, p = 0.001); thus, bradygastria contributes to the development of symptoms of “gastric” postprandial hypoglycemia. Conclusions. The highest risk of developing hypoglycemic conditions was found in patients with diabetic gastroparesis who underwent insulin therapy for the correction of carbohydrate metabolism. The determination of the motor-evacuation function of the stomach is recommended for patients with type 2 diabetes mellitus for both the prevention of postprandial hypoglycemia and early diagnosis of gastroparesis.

Keywords


type 2 diabetes mellitus; motor-evacuation function of the stomach; 13C-octanoate breath test; hypoglycemia

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DOI: https://doi.org/10.22141/2224-0721.13.3.2017.104110

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