American Diabetes Association Annual Meeting, June 2003
Gastrointestinal and dietary aspects of diabetes
- Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Diabetes Center, Mount Sinai School of Medicine, New York, New York.
At the 63rd annual scientific session of the American Diabetes Association (ADA), held in New Orleans, Louisiana, June 2003, a number of fascinating topics were discussed. This is the first of approximately six articles reviewing presentations at this meeting.
Diagnosis and treatment of gastrointestinal complications
Mark Burge, Albuquerque, New Mexico, introduced the topic of diabetic gastroparesis. The role of the stomach is to mix, pulverize, and deliver food to the duodenum. Gastric motor activity is controlled by many factors, including extrinsic parasympathetic and sympathetic and intrinsic enteric nerves and hormones such as gastrin, motilin, glucagon-like peptide-1, neuropeptide-Y, and nitric oxide. The glucagon-like peptide-1 agonist NN-211 delays gastric emptying in people with diabetes and may be beneficial for the overly rapid gastric emptying, which appears to worsen postprandial glycemia, of many individuals with type 1 diabetes. Gastric peristalsis is controlled by electrical impulses originating from gastric pacemaker cells, depolarizing three times per minute, with the fundus exhibiting receptive relaxation, while the antrum has regular contractions leading to vigorous mixing and grinding. Gastroparesis is potentiated by a number of factors, including gastric dysrhythmia, discoordination of antral contractions, failure of the fundus to relax, and hypomotility or inappropriate dilation of the antrum. Nausea, particularly following meals, vomiting, abdominal pain, bloating with malodorous eructation, early satiety, and anorexia are usual symptoms, although not typically with weight loss, which may indicate an eating disorder or additional gastrointestinal illness.
There is poor relationship between the severity of gastropathy and the symptoms exhibited by a given person. For many patients, erratic glycemia, Burge noted, are “the only clue.” This is complicated, however, as hyperglycemia delays gastric emptying of solids and liquids in individuals without diabetes; therefore, those with poorly controlled diabetes may only appear to have gastroparesis, showing the importance of achieving glycemic control. As symptoms alone are insufficient, it is important to …
