Oesophageal dysmotility, delayed gastric emptying and autonomic neuropathy correlate to disturbed glucose homeostasis.
OBJECTIVE
Among diabetic patients, glucose homeostasis may be affected by abnormal gastrointestinal motility and autonomic neuropathy. This study analysed whether oesophageal dysmotility, delayed gastric emptying or autonomic neuropathy affect glucose homeostasis.


METHODS
Oesophageal manometry and gastric emptying scintigraphy were performed in 20 diabetic patients. Heart-rate variation during deep breathing (expiration/inspiration [E/I] ratio) and continuous subcutaneous glucose concentrations for a period of 72 h were also monitored in the same patients.


RESULTS
Oesophageal dysmotility was found in eight of 14 patients. Eleven of 20 patients had delayed gastric emptying (abnormal gastric emptying half-time [T (50)]) and nine of 18 had an abnormal E/I ratio. Complaints of abdominal fullness were predictive of delayed gastric emptying. A low peristaltic speed of the oesophagus was associated with impaired T (50) (r ( s )=-0.67; p=0.02). One hour after breakfast, subcutaneous glucose levels decreased in patients with delayed gastric emptying but continued to rise in those with normal emptying. Consequently, the median glucose level 2.5 h after breakfast was lower in the former (9.1 [4.2-12.5] vs 14.3 [11.2-17.7] mmol/l; p<0.05). Glucose fluctuations during the 72 h were significantly higher in patients with an abnormal E/I ratio than in those with a normal E/I ratio (coefficient of variation: 41 [46-49] vs 28 [27-34]%; p=0.008).


CONCLUSIONS
Abdominal fullness predicted delayed gastric emptying that was associated with diminished glucose uptake after breakfast. Low oesophageal peristaltic speed was associated with slow gastric emptying whereas parasympathetic neuropathy was associated with increased glucose variations.
Ohlsson
B
B
Department of Clinical Sciences, Gastroenterology Division, Malmö University Hospital, Lund University, Malmö, Sweden. bodil.ohlsson@med.lu.se
Melander
O
O
Thorsson
O
O
Olsson
R
R
Ekberg
O
O
Sundkvist
G
G
D001342:Autonomic Nervous System Diseases / Q000097:blood / Q000473:pathology / Q000503:physiopathology*; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000473:pathology / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000097:blood / Q000473:pathology / Q000503:physiopathology*; D015154:Esophageal Motility Disorders / Q000097:blood / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005746:Gastric Emptying; D005769:Gastrointestinal Motility; D006706:Homeostasis; D006801:Humans; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose