Relationships between diabetic gastroparesis and risk of developing hypoglycemic conditions

Main Article Content

I.O. Kostitska
B.M. Mankovsky


Background. The purpose of the research was to study the motor-evacuation function of the stomach in order to determine the risk of developing hypoglycemic conditions in patients with type 2 diabetes mellitus. Materials and methods. The study included 112 (62 males and 50 females) patients at the age of 35–76 years with type 2 diabetes mellitus. Depending on antihyperglycemic therapy, there were 4 groups: group I — sulfonylureas + metformin; group II — sulfonylureas + metformin + dipeptidyl peptidase 4 inhibitor/glucagon-like peptide-1 analogue/sodium-glucose linked transporter-2 inhibitor/alpha-glucosidase inhibitors; group III — insulin therapy; group IV — insulin therapy + sulfonylureas + metformin/insulin therapy + metformin. To evaluate the motor function of the stomach, the PAGI-SYM (The Patient Assessment of Gastrointestinal Disorders Symptom Severity Index) and GCSI (Gastroparesis Cardinal Symptom Index) questionnaires as well as the 13C-octanoate breath test were used. The incidence and the severity of low blood sugar symptoms were assessed using the scales of the Hypoglycemia Fear Survey. Results. The results of the PAGI-SYM and GCSI questionnaires as well as the 13C-octanoate breath test indicated a uniform distribution of patients with slowing down of the motor-evacuation function of the stomach. When comparing patients with symptoms of bradygastria and those without them, hypoglycemic conditions were observed by 2.2–3.5 times more often in patients with the signs of diabetic gastroparesis. There was a correlation between the total score of the Hypoglycemia Fear Survey and the results of the 13C-octanoate breath test (r = 0.54, p = 0.001); thus, bradygastria contributes to the development of symptoms of “gastric” postprandial hypoglycemia. Conclusions. The highest risk of developing hypoglycemic conditions was found in patients with diabetic gastroparesis who underwent insulin therapy for the correction of carbohydrate metabolism. The determination of the motor-evacuation function of the stomach is recommended for patients with type 2 diabetes mellitus for both the prevention of postprandial hypoglycemia and early diagnosis of gastroparesis.

Article Details

How to Cite
Kostitska, I., and B. Mankovsky. “Relationships Between Diabetic Gastroparesis and Risk of Developing Hypoglycemic Conditions”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 13, no. 3, June 2017, pp. 143-9, doi:10.22141/2224-0721.13.3.2017.104110.
Original Researches


Akhmadullina GI, Kurnikova IA, Nurullina GM. Systemic disorders, comorbid disease and stomach function in patients with type 2 diabetes. Mezhdunarodnyj nauchno-issledovatel'skij zhurnal. 2016;5(47):125-132. (In Russian). doi: 10.18454/IRJ.2016.47.096.

Garbuzova MA. Control of glycemia is the key to successful prevention of complications in diabetes mellitus. Consilium Medicum. 2014;4:27-30. (In Russian).

Zvyagintseva TD, Chernobay AI. Functional gastrointestinal diseases and their combinations in view of the modern concepts: from pathogenesis to treatment. Suchasna gastroenterologija. 2015;3(83):61-72. (In Ukrainian).

Ismailov SI, Muminova SU. The role of questionnaires in the evaluation of quality of life of patients with diabetes mellitus (literature review). Mezhdunarodnyi Endokrinologicheskii Zhurnal. 2016;2(74):152-157. (In Russian). doi: 10.22141/2224-0721.2.74.2016.70963.

Kravchyn NA. Diabetic gastroenteropathy. Zdorov’ja Ukrainy. 2011;1(15):44 (In Russian).

Liashuk PM, Skhodnytskyi IV, Liashuk RP, Stankova NI. Hypoglycemic syndrome (literature review). Bukovyns'kyy medychnyy visnyk. 2014;1(69):159-63. (In Ukrainian).

Tayupova DS, Valeeva FV, Bareeva LT. Functional diagnosis of gastrointestinal form of diabetic autonomic neuropathy. Innovacionnye tehnologii v medicine. 2015;4(89):136-8. (In Russian).

Tkach SM. Functional dyspepsia in the light of the ROME IV criteria. Gastroenterology. 2016;4(62):65-71. (In Russian). doi: 10.22141/2308-2097.4.62.2016.81097.

Fadeenko GD, Chernishov VA. The gastroduodenal injuries in patients with diabetes mellitus: clinical and population prevalence aspects. Liky Ukrai'ny. 2011;7(153):48-50. (In Ukrainian).

Fillippov YuI. Gastroenterological disorders in diabetic neuropathy. Vrach. 2011;4:96-101. (In Russian).

Cukrovij dіabet 2 tipu adaptovana klіnіchna nastanova, zasnovana na dokazah. – Nakaz Mіnіsterstva ohoroni zdorov’ja Ukraїni № 1118 vіd 21.12.2012 [On approval and implementation of medical and technical documents on standardization of medical care in type 2 diabetes. The order of Ministry of Health of Ukraine N 118 dated 21.12.2012. (In Ukrainian).

Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014;14:528-50. doi: 10.1007/s11892-014-0528-7.

Bharucha AE, Batey-Schaefer B, Cleary PA, et al. Delayed gastric emptying is associated with early and long-term hyperglycemia in type 1 diabetes mellitus. Gastroenterology. 2015;149(2):330-9. doi: 10.1053/j.gastro.2015.05.007.

Boulton AJ, Kempler P, Ametov A, Ziegler D. Whither pathogenetic treatments for diabetic polyneuropathy? Diabetes Metab Res Rev. 2013;29(5):327-33. doi: 10.1002/dmrr.2397.

Dholakia S, Sharples EJ, Friend PJ. Impact of Pancreas Transplant on Diabetic Complications: Retinoparhy, Gastroparesis and Automatic Dysregulation. Curr Transpl Rep. 2016;3:167-73. doi: 10.1007/s40472-016-0101-1.

Friedenberg FK, Kowalczyk M, Parkman HP. The influence of race on symptom severity and quality of life in gastroparesis. J Clin Gastroenterol. 2013;47:757-61. doi: 10.1097/MCG.0b013e3182819aae.

Gonder-Frederick LA, Schmidt KM, Vajda KA, et al. Psychometric Properties of the Hypoglycemia Fear Survey-II for Adults With Type 1 Diabetes. Diabetes Care. 2011;34(2):801-6. doi: 10.2337/dc10-1343.

Halland M, Bharucha AE. Relationship Between Control of Glycemia and Gastric Emptying Disturbances in Diabetes Mellitus. Clin Gastroenterol Hepatol. 2016;14(7):929-36. doi: 10.1016/j.cgh.2015.11.021.

Hasler WL, Belt P, Wilson L, et al. Correlation of Fermentable Carbohydrate Consumption With Symptoms and Quality of Life in Patients With Diabetic and Idiopathic Gastroparesis. Gastroenterology. 2014 May;146(5):610. doi: 10.1016/S0016-5085(14)62207-1.

International Diabetes Federation (IDF). Diabetes Atlas. 7th ed. Vancouver, Canada; 2015.

Janssen P, Harris MS, Jones M, et al. The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis. Am J Gastroenterol. 2013;108:1382-91. doi: 10.1038/ajg.2013.118.

Martin CL, Albers JW, Pop-Busui R; DCCT/ EDIC Research Group. Neuropathy and related findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study. Diabetes Care. 2014;37:31-8. doi: 10.2337/dc13-2114.

Olausson EA, Storsrud S, Grundin H, Isaksson M, Attvall S, Simren M. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol. 2014 May;109(3):375-85. doi: 10.1038/ajg.2013.453.

Sadiya A. Nutritional therapy for the management of diabetic gastroparesis: clinical review. Diabetes, Metabolic Syndrome and Obesity. 2012;5:329-35. doi: 10.2147/DMSO.S31962.

Tack J, Vanormelingen C. Management of gastroparesis: beyond basics. Curr Treat Options Gastroenterol. 2014;12(4):468-77. doi: 10.1007/s11938-014-0034-7.

Törnblom H. Treatment of gastrointestinal autonomic neuropathy. Diabetologia. 2016;59:409-413. doi: 10.1007/s00125-015-3828-9.

Tseng P-HH, Lee Y-CC, Chiu, H-MM, et al. Association of diabetes and HbA1c levels with gastrointestinal manifestations. Diabetes Care. 2012;35:1053-1060. doi: 10.2337/dc11-1596.

William TC, Ratner RE. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: The “Gift” That Keeps on Giving! Diabetes Care. 2014;37(1):5-7. doi: 10.2337/dc13-2369.

Zilliox LA, Ruby SK, Singh S, Zhan M, Russell JW. Clinical neuropathy scales in neuropathy associated with impaired glucose tolerance. J Diabetes Complications. 2015;29(2):372-7. doi: 10.1016/j.jdiacomp.2015.01.011.