GI Dysfunctions in Diabetic Gastroenteropathy, Their Relationships With Symptoms, and Effects of a GLP-1 Antagonist
Subhankar Chakraborty  Magnus Halland  Duane Burton Anshuman Desai  Bridget Neja  Phillip Low  Wolfgang Singer Michael Camilleri  Alan R Zinsmeister  Adil E Bharucha
The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 6, June 2019, Pages 1967–1977, https://doi.org/10.1210/jc.2018-01623
Published: 24 October 2018  Article history
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Abstract
Context
Delayed gastric emptying (GE) is common but often asymptomatic in diabetes. The relationship between symptoms, glycemia, and neurohormonal functions, including glucagonlike peptide 1 (GLP-1), are unclear.

Objectives
To assess whether GE disturbances, symptoms during a GE study, and symptoms during enteral lipid infusion explain daily symptoms and whether GLP-1 mediates symptoms during enteral lipid infusion.

Design
In this randomized controlled trial, GE, enteral lipid infusion, gastrointestinal (GI) symptoms during these assessments, autonomic functions, glycosylated hemoglobin (HbA1c), and daily GI symptoms (2-week Gastroparesis Cardinal Symptom Index diary) were evaluated. During enteral lipid infusion, participants received the GLP-1 antagonist exendin 9-39 or placebo.

Setting
Single tertiary referral center.

Participants
24 healthy controls and 40 patients with diabetic gastroenteropathy.

Main Outcome Measures
GE, symptoms during enteral lipid infusion, and the effect of exendin 9-39 on the latter.

Results
In patients, GE was normal (55%), delayed (33%), or rapid (12%). During lipid infusion, GI symptoms tended to be greater (P = 0.06) in patients with diabetes mellitus (DM) than controls; exendin 9-39 did not affect symptoms. The HbA1c was inversely correlated with the mean symptom score during the GE study (r = −0.46, P = 0.003) and lipid infusion (r = −0.47, P < 0.01). GE and symptoms during GE study accounted for 40% and 32%, respectively, of the variance in daily symptom severity and quality of life.

Conclusions
In DM gastroenteropathy, GE and symptoms during a GE study explain daily symptoms. Symptoms during enteral lipid infusion were borderline increased but not reduced by a GLP-1 antagonist.

Issue Section: Diabetes, Pancreatic and Gastrointestinal Hormones
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