Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Neurology, Mayo Clinic, Rochester, Minnesota.
J Clin Endocrinol Metab. 2019 Jun 1;104(6):1967-1977. doi: 10.1210/jc.2018-01623.
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.
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.
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.
Single tertiary referral center.
24 healthy controls and 40 patients with diabetic gastroenteropathy.
GE, symptoms during enteral lipid infusion, and the effect of exendin 9-39 on the latter.
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.
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.
胃排空延迟（GE）在糖尿病中很常见，但通常无症状。症状、血糖和神经激素功能（包括胰高血糖素样肽 1（GLP-1））之间的关系尚不清楚。
评估 GE 紊乱、GE 研究期间的症状以及肠内脂质输注期间的症状是否可以解释日常症状，以及 GLP-1 是否介导肠内脂质输注期间的症状。
在这项随机对照试验中，评估了 GE、肠内脂质输注、这些评估期间的胃肠道（GI）症状、自主神经功能、糖化血红蛋白（HbA1c）以及 2 周的 GI 症状（胃轻瘫综合症状指数日记）。在肠内脂质输注期间，参与者接受了 GLP-1 拮抗剂 exendin 9-39 或安慰剂。
单一的三级转诊中心。
24 名健康对照者和 40 名糖尿病性胃肠病患者。
GE、肠内脂质输注期间的症状以及 exendin 9-39 对后者的影响。
在患者中，GE 正常（55%）、延迟（33%）或快速（12%）。在脂质输注期间，与对照组相比，糖尿病患者的 GI 症状往往更严重（P = 0.06）；exendin 9-39 对症状没有影响。HbA1c 与 GE 研究期间的平均症状评分呈负相关（r = -0.46，P = 0.003）和脂质输注（r = -0.47，P <0.01）。GE 和 GE 研究期间的症状分别解释了日常症状严重程度和生活质量的 40%和 32%的差异。
在糖尿病性胃肠病中，GE 和 GE 研究期间的症状可以解释日常症状。肠内脂质输注期间的症状略有增加，但 GLP-1 拮抗剂并未减少。
