title: Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, placebo controlled trial.
abstract: BACKGROUND
  Erythromycin, a motilin agonist, is a potent prokinetic. ABT-229 is a specific motilin agonist that dose dependently accelerates gastric emptying. Dyspepsia and gastroparesis are common problems in type 1 diabetes mellitus. We aimed to evaluate the efficacy of ABT-229 in symptomatic diabetic patients with and without delayed gastric emptying.
  
  
  METHODS
  Patients with type 1 diabetes and postprandial symptoms were randomised (n=270). Based on a validated C(13) octanoic acid breath test, patients were assigned to either the delayed or normal gastric emptying strata. Patients received one of four doses of ABT-229 (1.25, 2.5, 5, or 10 mg twice daily before breakfast and dinner) or placebo for four weeks following a two week baseline. A self report questionnaire measured symptoms on visual analogue scales; the primary outcome was assessment of change in the total upper abdominal symptom severity score (range 0-800 mm) from baseline to the final visit.
  
  
  RESULTS
  The treatment arms were similar regarding baseline characteristics. There was symptom improvement on placebo and a similar level of improvement on active therapy for the upper abdominal discomfort severity score (mean change from baseline -169, -101, -155, -143, and -138 mm for placebo, and 1.25, 2.5, 5, and 10 mg ABT-229, respectively, at four weeks by intent to treat). The results were not significantly different in those with and without delayed gastric emptying. The severity of bloating, postprandial nausea, epigastric discomfort, heartburn, and acid regurgitation worsened dose dependently in a greater number of patients receiving ABT-229 than placebo. Overall, 63% of patients on placebo reported a good or excellent global response, and this was not different from the active treatment arms.
  
  
  CONCLUSIONS
  The motilin agonist ABT-229 was not efficacious in the relief of postprandial symptoms in diabetes mellitus in the presence or absence of delayed gastric emptying.
authors.affiliation: Department of Medicine, University of Sydney, Nepean Hospital, Penrith NSW, Australia.
authors.forename: N J
authors.initials: NJ
authors.lastname: Talley
authors.forename: M
authors.initials: M
authors.lastname: Verlinden
authors.forename: D J
authors.initials: DJ
authors.lastname: Geenen
authors.forename: R B
authors.initials: RB
authors.lastname: Hogan
authors.forename: D
authors.initials: D
authors.lastname: Riff
authors.forename: R W
authors.initials: RW
authors.lastname: McCallum
authors.forename: R J
authors.initials: RJ
authors.lastname: Mack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001944:Breath Tests; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004415:Dyspepsia / Q000188:drug therapy* / Q000209:etiology; D004917:Erythromycin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D018589:Gastroparesis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009037:Motilin / Q000819:agonists*; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D009037:Motilin; C114264:Alemcinal; D004917:Erythromycin