Glucoregulation in Diabetic Patients with Delayed Gastric Emptying

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 818-841-Diabetes Pathophysiology & Complications
Basic/Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-826
Suneetha Vysetti*1, Shalini Paturi2, Boby George Theckedath3, Janice L Gilden4, Janine Stoll5 and Rosemary Trotta6
1Captain James A Lovell Federal H, Vernon Hills, IL, 2Rosalind Franklin University of Medicine and Science/Chicago Medical School, Green Oaks, IL, 3Capt. James A Lovell FHCC, North Chicago, IL, 4RFUMS/Chicago Med Schl, Chicago, IL, 5Capt James A Lovell FHCC, North Chicago, IL, 6Capt. James A Lovell Federal Health Care Center, North Chicago, IL
Background:  Although glycemic control is important for prevention of complications in Diabetes Mellitus (DM), ACCORD and ADVANCE studies suggest that mortality is higher in patients with extremely tight glucose control, especially in those with longer DM duration and already established chronic complications, such as coronary artery disease (CAD), nephropathy (MA),  peripheral neuropathy (DPN), and autonomic neuropathy (AN): gastroparesis (GP) and orthostatic hypotension (NOH). Increased hypoglycemia (HYPO) may be responsible for further autonomic failure (AN), and sudden death. However, the effects of AN on glucoregulation are controversial.    Therefore, we evaluated whether HYPO is common in DM with symptomatic GP.

Methods: A retrospective chart review of 77 DM identified 30 male patients [(8 Type1:22 Type 2)(28 treated with insulin)(aged 64.5 ± 2.0 yrs)(duration of DM= 20.4±11.7 yrs)(CAD; n=10) (HTN; n=28)(NOH; n=6); DPN, abnormal monofilament; n=20)(Bezett QTc intervals= 443±4.5 mm)(MA, urine µalb/cr ratio =3.7–5935)(Hgba1c= 8.2 ±1.9%)(BMI= 32±1)] with symptoms typical for gastroparesis  (bloating, early satiety, nausea, vomiting, postmeal discomfort), and no other GI pathology, who had the 72 hr continuous glucose monitoring (CGMS) testing with unbiased glucose measurements.  Glucose values were then mathematically transformed into % time above normal (>140 mg%), % normal (70-140 mg%), and % below normal (<70 mg%) for 3 time intervals: (T1=0600-1800hrs); (T2=1800-2400hrs); (T3=2400-0600hrs). Glucose averages for the 72 hr time period were also calculated. Delayed gastric emptying was defined by T 1/2with 99 Tc labeled solid food of > 70 minutes after 1 hr.

Results:   Patients with T 1/2 of <70  had less DPN (p<0.01) and NOH (p<0.01), and demonstrated a higher rate %BN for T3 (17.6 ± 8.1 vs 3.8 ±1.6; p<0.05), as well as for overall %BN (9.5 ±3.1 vs 3.4 ±1.1; p<0.05). A greater T 1/2 was observed in DM with higher QTc (r2=0.4) and MA (r2=0.4); p<0.05).  Furthermore, those DM with higher QTc also had more NOH (r2=0.5; p<0.001), higher HR (r2=0.05;p<0±.01), and higher %ANT1 (p<0.01).  DM with DPN also had more CAD and AN (r2=0.06: r2=0.04; p<0.01).

Conclusions: Diabetic patients with T 1/2<70 minutes and lower QTc have higher overall hypoglycemia, as well as during the overnight hours. Therefore, glucoregulation may depend upon the integrity of the autonomic nervous system, as well as the chronic complications of diabetes mellitus.

Nothing to Disclose: SV, SP, BGT, JLG, JS, RT

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Acknowledgements: Research sponsored by JAL FHCC