title: Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered caecal pH profile.
abstract: We hypothesised that type 1 diabetic patients with established diabetic sensorimotor polyneuropathy (DSPN) would have segmental and/or pan-enteric dysmotility in comparison to healthy age-matched controls. We aimed to investigate the co-relationships between gastrointestinal function, degree of DSPN and clinical symptoms.
  
  
  
  An observational comparison was made between 48 patients with DSPN (39 men, mean age 50 years, range 29-71 years), representing the baseline data of an ongoing clinical trial (representing a secondary analysis of baseline data collected from an ongoing double-blind randomised controlled trial investigating the neuroprotective effects of liraglutide) and 41 healthy participants (16 men, mean age 49 years, range 30-78) who underwent a standardised wireless motility capsule test to assess gastrointestinal transit. In patients, vibration thresholds, the Michigan Neuropathy Screening Instrument and Patient Assessment of Upper Gastrointestinal Symptom questionnaires were recorded.
  
  
  
  Compared with healthy controls, patients showed prolonged gastric emptying (299 ± 289 vs 179 ± 49 min; p = 0.01), small bowel transit (289 ± 107 vs 224 ± 63 min; p = 0.001), colonic transit (2140, interquartile range [IQR] 1149-2799 min vs 1087, IQR 882-1650 min; p = 0.0001) and whole-gut transit time (2721, IQR 1196-3541 min vs 1475 (IQR 1278-2214) min; p < 0.0001). Patients also showed an increased fall in pH across the ileocaecal junction (-1.8 ± 0.4 vs -1.3 ± 0.4 pH; p < 0.0001), which was associated with prolonged colonic transit (r = 0.3, p = 0.001). Multivariable regression, controlling for sex, disease duration and glycaemic control, demonstrated an association between whole-gut transit time and total GCSI (p = 0.02).
  
  
  
  Pan-enteric prolongation of gastrointestinal transit times and a more acidic caecal pH, which may represent heightened caecal fermentation, are present in patients with type 1 diabetes. The potential implication of delayed gastrointestinal transit on the bioavailability of nutrition and on pharmacotherapeutic and glycaemic control warrants further investigation.
  
  
  
  EUDRA CT: 2013-004375-12.
authors.affiliation: Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, UK.|Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.|Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Farmer
authors.affiliation: Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark.|Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Anne Grave
authors.initials: AG
authors.lastname: Pedersen
authors.affiliation: Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Brock
authors.affiliation: Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Poul Erik
authors.initials: PE
authors.lastname: Jakobsen
authors.affiliation: Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Karmisholt
authors.affiliation: Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Sahar D
authors.initials: SD
authors.lastname: Mohammed
authors.affiliation: Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: S Mark
authors.initials: SM
authors.lastname: Scott
authors.affiliation: Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark.
authors.forename: Asbjørn Mohr
authors.initials: AM
authors.lastname: Drewes
authors.affiliation: Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark. christina.brock@rn.dk.|Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. christina.brock@rn.dk.|Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark. christina.brock@rn.dk.
authors.forename: Christina
authors.initials: C
authors.lastname: Brock
mesh_terms: D000328:Adult; D000368:Aged; D002432:Cecum / Q000382:microbiology* / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism* / Q000503:physiopathology*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000378:metabolism* / Q000503:physiopathology*; D013997:Time Factors
keywords: Caecal fermentation; Diabetes mellitus; Gastrointestinal dysfunction; Gastrointestinal transit; Pan-enteric dysfunction; SmartPill