The impact of gastroparesis on diabetes control: Patient perceptions

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Abstract

The impact of gastroparesis on diabetes management and control from the patient perspective has not been well characterized. The aim of this study was to identify patient perceptions regarding the impact of gastroparesis on managing their diabetes.

Methods

Patients with diabetes being referred for gastroparesis were enrolled in this prospective study. Gastroparetic symptom severity was assessed with the Patient Assessment of Upper GI Symptoms (PAGI-SYM). A questionnaire examined the impact of gastroparesis on diabetes related symptoms and control.

Results

54 diabetic gastroparesis patients (36 T1DM, 18 T2DM) participated. Duration of diabetes averaged 17.4 ± 1.4 years and gastroparetic symptoms 5.1 ± 1.1 years. Patients rated their most severe symptoms as postprandial fullness, early satiety, and nausea. Two thirds of diabetic subjects identified that since their diagnosis of gastroparesis, their diabetes was more difficult to control (44 of 54 patients) and that extra time and effort were required for care of their diabetes (45 of 54). Patients with T1DM, compared to those with T2DM, more often expressed that since developing gastroparesis, their blood sugars have been higher, they have had more frequent episodes of hypoglycemia, and they found that their gastroparetic symptoms worsened if blood sugars were too high.

Conclusions

Gastroparesis has a significant impact on patients’ perceived ability to self-manage and control their diabetes. T1DM patients, in particular, associate their gastroparesis with episodes of hyper- and hypo-glycemia, and find their gastroparetic symptoms worsen with poor control. Future research should focus on strategies to support self-management of patients with diabetic gastroparesis.

Introduction

Delayed gastric emptying is a common complication in many patients with long standing diabetes mellitus. Gastroparesis affects approximately 30% to 40% of individuals with type 1 (T1DM) and about 20% of individuals with type 2 diabetes (T2DM) (Horowitz et al., 2002, Intagliata and Koch, 2007, Samson et al., 2003). However, the effects of the delayed emptying are variable with some individuals exhibiting only mild symptoms while others experience severe nausea, vomiting and fullness. The cause of diabetic gastroparesis is still not well understood but is likely to be multifactorial in nature including factors such as vagal neuropathy, enteric nerve dysfunction, and hyperglycemia (Horowitz et al., 2002).

Diabetic gastroparesis has been associated with poor glycemic control and increased frequency of hypoglycemia as well as a reduced quality of life (De Kort et al., 2012, Talley, Bytzer, et al., 2001, Talley, Young, et al., 2001). From a health provider perspective, the difficulties of achieving good glycemic control in diabetic patients with gastroparesis are known (Rayner & Horowitz, 2006). In diabetic gastroparesis, nausea, vomiting, and early satiety and the delayed gastric emptying can make glucose control difficult. In patients with gastroparesis treated with insulin, the delays in gastric emptying can result in severe hypoglycemia immediately following meals due to the delayed emptying of the meal from the stomach which is then followed by a period of hyperglycemia as the insulin effects wane and the meal is finally absorbed (Cherian & Parkman, 2012). This is all exacerbated by the fact that the rate of gastric emptying is often unpredictable and mediated by a number of different factors (Chang, Rayner, Jones, & Horowitz, 2010).

While the effect of gastroparesis on diabetes management and control has been described from the provider perspective, the impact of gastroparesis on diabetes management and control from the patient perspective has not been well characterized. The aim of this study was to identify the perceptions of diabetic patients regarding the impact of gastroparesis on managing their diabetes. Through this study, we wished to gain insight to help improve patients understanding of diabetic gastroparesis.

Section snippets

Methods

The study population consisted of patients with diabetes, either T1DM or T2DM, who have gastroparesis. Subjects were recruited from gastroparesis patients referred to the senior author (HPP) at the GI practices of Temple University Hospital. Subjects were of either sex and between the ages of 18 and 70 years. Subjects, with an established diagnosis of diabetes, were required to have delayed gastric emptying on gastric scintigraphy defined as greater than 60% retention at 2 h and/or greater than

Patients

Table 1 shows the demographic and clinical information in the patients with diabetic gastroparesis subdivided into T1DM and T2DM. As expected, individuals with type 2 diabetes were older and heavier than the individuals with type 1 diabetes. Fifty four individuals with diabetic gastroparesis (36 T1DM and 18 T2DM) participated. Fifty percent of individuals were being treated with medications for their gastroparesis. Of the individuals receiving medications, 19 were taking metoclopramide, 4 were

Discussion

This study of patients with diabetes with gastroparesis evaluates perceived effect of gastroparesis on their ability to self-manage and control their diabetes. Two thirds of the subjects studied identified that since their diagnosis of gastroparesis, their diabetes was more difficult to control and that extra time and effort were required for care of their diabetes. Half of the patients expressed that their gastroparesis symptoms worsen if their glucoses are not controlled whereas only a

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  • Cited by (0)

    Authors’ contributions: Carol Homko, RN, PhD: study concept and design; analysis and interpretation of data; drafting of manuscript; statistical analysis. Elias S. Siraj, MD: critical revision of the manuscript for important intellectual content. Henry P. Parkman, MD: study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; study supervision.

    No relevant conflicts of interest.

    Funding for study: none.

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