title: Delayed Gastric Emptying Is Associated With Early and Long-term Hyperglycemia in Type 1 Diabetes Mellitus.
abstract: OBJECTIVE
  After the Diabetes Control and Complications Trial (DCCT), the Epidemiology of Diabetes Interventions and Complications (EDIC) study continued to show persistent benefit of prior intensive therapy on neuropathy, retinopathy, and nephropathy in type 1 diabetes mellitus (DM). The relationship between control of glycemia and gastric emptying (GE) is unclear.
  
  
  METHODS
  We assessed GE with a (13)C-spirulina breath test and symptoms in 78 participants with type 1 diabetes at year 20 of EDIC. The relationship between delayed GE and glycated hemoglobin (HbA1c), complications of DM, and gastrointestinal symptoms were evaluated.
  
  
  RESULTS
  GE was normal (37 participants; 50%), delayed (35 participants; 47%), or rapid (2 participants; 3%). The latest mean HbA1c was 7.7%. In univariate analyses, delayed GE was associated with greater DCCT baseline HbA1c and duration of DM before DCCT (P ≤ .04), greater mean HbA1c over an average of 27 years of follow-up evaluation (during DCCT-EDIC, P = .01), lower R-R variability during deep breathing (P = .03) and severe nephropathy (P = .05), and a greater composite upper gastrointestinal symptom score (P < .05). In multivariate models, retinopathy was the only complication of DM associated with delayed GE. Separately, DCCT baseline HbA1c (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.3) and duration of DM (OR, 1.2; 95% CI, 1.01-1.3) before DCCT entry and mean HbA1c during DCCT-EDIC (OR, 2.2; 95% CI, 1.04-4.5) were associated independently with delayed GE.
  
  
  CONCLUSIONS
  In the DCCT/EDIC study, delayed GE was remarkably common and associated with gastrointestinal symptoms and with measures of early and long-term hyperglycemia. ClinicalTrials.gov numbers NCT00360815 and NCT00360893.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: bharucha.adil@mayo.edu.
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.affiliation: Division of Endocrinology, Northwestern University, Chicago, Illinois.
authors.forename: Barbara
authors.initials: B
authors.lastname: Batey-Schaefer
authors.affiliation: Biostatistics Center, George Washington University, Washington, District of Columbia.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.affiliation: Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Washington, District of Columbia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cowie
authors.affiliation: Division of Endocrinology, University of California-San Diego, San Diego, California.
authors.forename: Gayle
authors.initials: G
authors.lastname: Lorenzi
authors.affiliation: Division of Endocrinology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Marsha
authors.initials: M
authors.lastname: Driscoll
authors.affiliation: Division of Endocrinology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: Harth
authors.affiliation: Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Mary
authors.initials: M
authors.lastname: Larkin
authors.affiliation: Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Marielle
authors.initials: M
authors.lastname: Christofi
authors.affiliation: Division of Endocrinology, University of Iowa General Hospital, Iowa City, Iowa.
authors.forename: Margaret
authors.initials: M
authors.lastname: Bayless
authors.affiliation: Division of Endocrinology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Nyra
authors.initials: N
authors.lastname: Wimmergren
authors.affiliation: Division of Endocrinology, University of Michigan, Ann Arbor, Michigan.
authors.forename: William
authors.initials: W
authors.lastname: Herman
authors.affiliation: Department of Endocrinology, Henry Ford Medical-New Center One, Detroit, Michigan.
authors.forename: Fred
authors.initials: F
authors.lastname: Whitehouse
authors.affiliation: Department of Endocrinology, Henry Ford Medical-New Center One, Detroit, Michigan.
authors.forename: Kim
authors.initials: K
authors.lastname: Jones
authors.affiliation: Department of Endocrinology, Henry Ford Medical-New Center One, Detroit, Michigan.
authors.forename: Davida
authors.initials: D
authors.lastname: Kruger
authors.affiliation: Division of Endocrinology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Cathy
authors.initials: C
authors.lastname: Martin
authors.affiliation: Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Georgia
authors.initials: G
authors.lastname: Ziegler
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.affiliation: Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
mesh_terms: D001786:Blood Glucose; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000453:epidemiology* / Q000209:etiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetic Gastroparesis; Glycemic Control; HbA1c; Neuropathy