TY - JOUR
T1 - Delayed gastric emptying is associated with early and long-term hyperglycemia in type 1 diabetes mellitus
AU - Bharucha, Adil E.
AU - Batey-Schaefer, Barbara
AU - Cleary, Patricia A.
AU - Murray, Joseph A.
AU - Cowie, Catherine
AU - Lorenzi, Gayle
AU - Driscoll, Marsha
AU - Harth, Judy
AU - Larkin, Mary
AU - Christofi, Marielle
AU - Bayless, Margaret
AU - Wimmergren, Nyra
AU - Herman, William
AU - Whitehouse, Fred
AU - Jones, Kim
AU - Kruger, Davida
AU - Martin, Cathy
AU - Ziegler, Georgia
AU - Zinsmeister, Alan R.
AU - Nathan, David M.
N1 - Publisher Copyright:
© 2015 by the AGA Institute.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background & Aims After the Diabetes Control and Complications Trial (DCCT), the Epidemiology of Diabetes Interventions and Complications (EDIC) study continued to show persistent benefit of prior intensive therapy on neuropathy, retinopathy, and nephropathy in type 1 diabetes mellitus (DM). The relationship between control of glycemia and gastric emptying (GE) is unclear. Methods We assessed GE with a 13C-spirulina breath test and symptoms in 78 participants with type 1 diabetes at year 20 of EDIC. The relationship between delayed GE and glycated hemoglobin (HbA1c), complications of DM, and gastrointestinal symptoms were evaluated. Results GE was normal (37 participants; 50%), delayed (35 participants; 47%), or rapid (2 participants; 3%). The latest mean HbA1c was 7.7%. In univariate analyses, delayed GE was associated with greater DCCT baseline HbA1c and duration of DM before DCCT (P â‰.04), greater mean HbA1c over an average of 27 years of follow-up evaluation (during DCCT-EDIC, P =.01), lower R-R variability during deep breathing (P =.03) and severe nephropathy (P =.05), and a greater composite upper gastrointestinal symptom score (P <.05). In multivariate models, retinopathy was the only complication of DM associated with delayed GE. Separately, DCCT baseline HbA1c (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.3) and duration of DM (OR, 1.2; 95% CI, 1.01-1.3) before DCCT entry and mean HbA1c during DCCT-EDIC (OR, 2.2; 95% CI, 1.04-4.5) were associated independently with delayed GE. Conclusions In the DCCT/EDIC study, delayed GE was remarkably common and associated with gastrointestinal symptoms and with measures of early and long-term hyperglycemia.
AB - Background & Aims After the Diabetes Control and Complications Trial (DCCT), the Epidemiology of Diabetes Interventions and Complications (EDIC) study continued to show persistent benefit of prior intensive therapy on neuropathy, retinopathy, and nephropathy in type 1 diabetes mellitus (DM). The relationship between control of glycemia and gastric emptying (GE) is unclear. Methods We assessed GE with a 13C-spirulina breath test and symptoms in 78 participants with type 1 diabetes at year 20 of EDIC. The relationship between delayed GE and glycated hemoglobin (HbA1c), complications of DM, and gastrointestinal symptoms were evaluated. Results GE was normal (37 participants; 50%), delayed (35 participants; 47%), or rapid (2 participants; 3%). The latest mean HbA1c was 7.7%. In univariate analyses, delayed GE was associated with greater DCCT baseline HbA1c and duration of DM before DCCT (P â‰.04), greater mean HbA1c over an average of 27 years of follow-up evaluation (during DCCT-EDIC, P =.01), lower R-R variability during deep breathing (P =.03) and severe nephropathy (P =.05), and a greater composite upper gastrointestinal symptom score (P <.05). In multivariate models, retinopathy was the only complication of DM associated with delayed GE. Separately, DCCT baseline HbA1c (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.3) and duration of DM (OR, 1.2; 95% CI, 1.01-1.3) before DCCT entry and mean HbA1c during DCCT-EDIC (OR, 2.2; 95% CI, 1.04-4.5) were associated independently with delayed GE. Conclusions In the DCCT/EDIC study, delayed GE was remarkably common and associated with gastrointestinal symptoms and with measures of early and long-term hyperglycemia.
KW - Diabetic Gastroparesis
KW - Glycemic Control
KW - HbA1c
KW - Neuropathy
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U2 - 10.1053/j.gastro.2015.05.007
DO - 10.1053/j.gastro.2015.05.007
M3 - Article
C2 - 25980755
AN - SCOPUS:84938070471
SN - 0016-5085
VL - 149
SP - 330
EP - 339
JO - Gastroenterology
JF - Gastroenterology
IS - 2
ER -