TY - JOUR
T1 - Gi dysfunctions in diabetic gastroenteropathy, their relationships with symptoms, and effects of a GLP-1 antagonist
AU - Chakraborty, Subhankar
AU - Halland, Magnus
AU - Burton, Duane
AU - Desai, Anshuman
AU - Neja, Bridget
AU - Low, Phillip
AU - Singer, Wolfgang
AU - Camilleri, Michael
AU - Zinsmeister, Alan R.
AU - Bharucha, Adil E.
N1 - Publisher Copyright:
© 2019 Endocrine Society
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Context: Delayed gastric emptying (GE) is common but often asymptomatic in diabetes. The relationship between symptoms, glycemia, and neurohormonal functions, including glucagonlike peptide 1 (GLP-1), are unclear. Objectives: To assess whether GE disturbances, symptoms during a GE study, and symptoms during enteral lipid infusion explain daily symptoms and whether GLP-1 mediates symptoms during enteral lipid infusion. Design: In this randomized controlled trial, GE, enteral lipid infusion, gastrointestinal (GI) symptoms during these assessments, autonomic functions, glycosylated hemoglobin (HbA1c), and daily GI symptoms (2-week Gastroparesis Cardinal Symptom Index diary) were evaluated. During enteral lipid infusion, participants received the GLP-1 antagonist exendin 9-39 or placebo. Setting: Single tertiary referral center. Participants: 24 healthy controls and 40 patients with diabetic gastroenteropathy. Main Outcome Measures: GE, symptoms during enteral lipid infusion, and the effect of exendin 9-39 on the latter. Results: In patients, GE was normal (55%), delayed (33%), or rapid (12%). During lipid infusion, GI symptoms tended to be greater (P = 0.06) in patients with diabetes mellitus (DM) than controls; exendin 9-39 did not affect symptoms. The HbA1c was inversely correlated with the mean symptom score during the GE study (r = 20.46, P = 0.003) and lipid infusion (r = 20.47, P, 0.01). GE and symptoms during GE study accounted for 40% and 32%, respectively, of the variance in daily symptom severity and quality of life. Conclusions: In DM gastroenteropathy, GE and symptoms during a GE study explain daily symptoms. Symptoms during enteral lipid infusion were borderline increased but not reduced by a GLP-1 antagonist.
AB - Context: Delayed gastric emptying (GE) is common but often asymptomatic in diabetes. The relationship between symptoms, glycemia, and neurohormonal functions, including glucagonlike peptide 1 (GLP-1), are unclear. Objectives: To assess whether GE disturbances, symptoms during a GE study, and symptoms during enteral lipid infusion explain daily symptoms and whether GLP-1 mediates symptoms during enteral lipid infusion. Design: In this randomized controlled trial, GE, enteral lipid infusion, gastrointestinal (GI) symptoms during these assessments, autonomic functions, glycosylated hemoglobin (HbA1c), and daily GI symptoms (2-week Gastroparesis Cardinal Symptom Index diary) were evaluated. During enteral lipid infusion, participants received the GLP-1 antagonist exendin 9-39 or placebo. Setting: Single tertiary referral center. Participants: 24 healthy controls and 40 patients with diabetic gastroenteropathy. Main Outcome Measures: GE, symptoms during enteral lipid infusion, and the effect of exendin 9-39 on the latter. Results: In patients, GE was normal (55%), delayed (33%), or rapid (12%). During lipid infusion, GI symptoms tended to be greater (P = 0.06) in patients with diabetes mellitus (DM) than controls; exendin 9-39 did not affect symptoms. The HbA1c was inversely correlated with the mean symptom score during the GE study (r = 20.46, P = 0.003) and lipid infusion (r = 20.47, P, 0.01). GE and symptoms during GE study accounted for 40% and 32%, respectively, of the variance in daily symptom severity and quality of life. Conclusions: In DM gastroenteropathy, GE and symptoms during a GE study explain daily symptoms. Symptoms during enteral lipid infusion were borderline increased but not reduced by a GLP-1 antagonist.
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U2 - 10.1210/jc.2018-01623
DO - 10.1210/jc.2018-01623
M3 - Article
C2 - 30358871
AN - SCOPUS:85064994048
SN - 0021-972X
VL - 104
SP - 1967
EP - 1977
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 6
ER -