Prevalence and predictors of delayed gastric emptying among Indian patients with long-standing type 2 diabetes mellitus.
OBJECTIVE
Upper gastrointestinal symptoms are more prevalent among type 2 diabetes mellitus (T2DM) patients. The prevalence of delayed gastric emptying (GE) and factors predictive of it have not been studied in Indian T2DM patients and the present study aimed to study the same.


METHODS
This hospital-based cross-sectional study involved adult (age between 18 and 65 years) outpatients with T2DM of ≥5-year duration. Measurements of GE of a labelled standardized solid rice idli meal by gastric emptying scintigraphy (GES), symptoms of delayed GE (by standardized questionnaire) and autonomic function by cardiovascular autonomic function tests (AFTs) were carried out. Thirty healthy subjects served as controls for GES and AFTs.


RESULTS
One hundred and forty T2DM patients (age range: 32-65 years) were studied. Delayed GE was documented in ≈29 % (40/140) and rapid GE in 2 % (3/140) of T2DM patients. Univariate analysis showed significant positive association between delayed GE and duration of DM, body mass index (BMI), HbA1c, retinopathy, peripheral neuropathy, autonomic dysfunction and coronary artery disease (p < 0.05 for all). However, there was no significant correlation of age, sex, symptoms suggestive of gastroparesis and nephropathy with delayed GE. Hypoglycemic episodes were significantly more frequent in those with delayed GE (p < 0.05). Multiple logistic regression analysis revealed only BMI and HbA1c to be significant independent predictors of delayed GE.


CONCLUSIONS
Presence and severity of symptoms of gastroparesis did not predict delayed GE. Delayed GE, irrespective of symptoms, was associated with microvascular and macrovascular diabetic complications and increased risk of hypoglycemic episodes. HbA1cand BMI were independent predictors of delayed GE.
Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, 605 006, India.
Venkata
V
Anudeep
Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, 605 006, India. drkvv@rediffmail.com.
Kolar Vishwanath
KV
Vinod
Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, 605 006, India.
Nandini
N
Pandit
Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, 605 006, India.
Vivek Kumar
VK
Sharma
Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, 605 006, India.
Halanaik
H
Dhanapathi
Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, 605 006, India.
Tarun Kumar
TK
Dutta
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, 605 006, India.
Akkilagunta
A
Sujiv
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D005544:Forecasting; D005746:Gastric Emptying; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology*; D006442:Glycated Hemoglobin; D006801:Humans; D007003:Hypoglycemia; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Autonomic dysfunction; Gastric emptying; Gastroparesis; Idli meal; Scintigraphy; Type 2 diabetes
Neurogastroenterol Motil. 2006 Jun;18(6):433-40
16700722
Australas Med J. 2014 Jan 31;7(1):45-8
24567766
Nucl Med Rev Cent East Eur. 2015 ;18(1):3-6
25633509
Aliment Pharmacol Ther. 2003 Jul 1;18(1):141-50
12848636
Gastroenterology. 2015 Aug;149(2):330-9
25980755
Diabet Med. 2002 Mar;19(3):177-94
11918620
Clin Physiol Funct Imaging. 2014 Mar;34(2):151-8
23953884
Gastroenterology. 2011 Aug;141(2):486-98, 498.e1-7
21684286
Arch Intern Med. 2001 Sep 10;161(16):1989-96
11525701
J Clin Gastroenterol. 1999 Sep;29(2):171-7
10478880
World J Gastroenterol. 2008 Mar 14;14(10):1564-9
18330949
Diabetologia. 1989 Mar;32(3):151-9
2753246
J Diabetes Complications. 2013 Jan-Feb;27(1):78-81
22981149
Diabet Med. 2008 May;25(5):570-7
18445170
Gastroenterology. 2009 Aug;137(2):445-52
19410575
Am J Gastroenterol. 2013 Jan;108(1):18-37; quiz 38
23147521
Diabetes Care. 2001 Jul;24(7):1264-9
11423513
Clin Nucl Med. 2014 Nov;39(11):960-5
25140554
Diabetes Res Clin Pract. 2011 Dec;94(3):311-21
22079683
Clin Gastroenterol Hepatol. 2011 Jan;9(1):5-12; quiz e7
20951838
Diabetes Care. 2003 Nov;26(11):3116-22
14578248
J Clin Gastroenterol. 2012 Mar;46(3):209-15
21959322