Northwestern University, Chicago, IL, United States.
Jaeb Center for Health Research, Tampa, FL, United States.
J Diabetes Complications. 2017 Dec;31(12):1669-1673. doi: 10.1016/j.jdiacomp.2017.08.014. Epub 2017 Sep 6.
To better understand the prevalence and impact of gastroparesis in the T1D Exchange clinic registry database.
The analysis included 7107 adult participants with T1D across 45 sites (median age 46years. and median duration 24years). Linear and logistic regression models were used to assess the association of gastroparesis vs. no gastroparesis (obtained from medical record) with demographic characteristics, glycemic control and diabetes complications.
Among 7107 registry participants, 340 (4.8%) had a clinical diagnosis of gastroparesis. Females were more likely to have gastroparesis compared with males (5.8% vs. 3.5%, P<0.001). Participants with gastroparesis compared with those without gastroparesis were older (median age 49.4 vs. 45.3years, P<0.001), had a longer duration of T1D (median duration 32 vs. 23years, P<0.001), higher mean HbA1c (8.1% vs. 7.7% [65 vs. 61mmol/mol], P<0.001), more frequent severe hypoglycemia (25% vs. 11% with ≥1 event in the past 12months, P<0.001), lower socio-economic status, less likely to be using CGM and insulin pump and greater prevalence of microvascular and neuropathic complications than participants without gastroparesis.
Gastroparesis is associated with higher risk of severe hypoglycemia despite higher HbA1c levels than in T1D patients without gastroparesis. The increased presence of multiple long-term complications and overall poor glycemic control in these subjects emphasizes the need to establish diagnostic protocols for earlier diagnosis, achieve tighter glycemic control with more extensive use of insulin pumps and continuous glucose monitoring, and the need for wider availability of medical therapies for treatment of diabetic gastroparesis.
更好地了解 gastroparesis 在 T1D Exchange 诊所注册数据库中的流行程度和影响。
分析纳入了来自 45 个地点的 7107 名成年 T1D 参与者（中位年龄 46 岁，中位病程 24 年）。采用线性和逻辑回归模型评估 gastroparesis 与无 gastroparesis（通过病历获得）与人口统计学特征、血糖控制和糖尿病并发症的相关性。
在 7107 名注册参与者中，有 340 人（4.8%）临床诊断为 gastroparesis。女性发生 gastroparesis 的可能性高于男性（5.8% vs. 3.5%，P<0.001）。与无 gastroparesis 的参与者相比，有 gastroparesis 的参与者年龄更大（中位数年龄 49.4 岁 vs. 45.3 岁，P<0.001），T1D 病程更长（中位数病程 32 年 vs. 23 年，P<0.001），平均 HbA1c 更高（8.1% vs. 7.7%[65 vs. 61mmol/mol]，P<0.001），更频繁发生严重低血糖（25% vs. 11%，过去 12 个月有≥1 次事件，P<0.001），社会经济地位较低，更不可能使用 CGM 和胰岛素泵，微血管和神经并发症的患病率也高于无 gastroparesis 的参与者。
尽管 gastroparesis 患者的 HbA1c 水平高于无 gastroparesis 的 T1D 患者，但 gastroparesis 与严重低血糖的风险增加相关。这些患者存在多种长期并发症，整体血糖控制不佳，这强调了需要建立早期诊断的诊断方案，通过更广泛地使用胰岛素泵和连续血糖监测来实现更严格的血糖控制，并需要更广泛地获得治疗糖尿病 gastroparesis 的医学治疗方法。
