Regional gastrointestinal <scp>pH</scp> profile is altered in patients with type 1 diabetes and peripheral neuropathy

Wegeberg, Anne-Marie; Brock, Christina; Brock, Birgitte; Farmer, Adam D.; Hobson, Anthony; Semler, John R.; Scott, S. M.

doi:10.1111/nmo.13407

Cited by 8 publications

(9 citation statements)

References 51 publications

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“…There was no significant demographic difference between the groups, except that more participants in the placebo group used insulin pumps rather than pens (11% vs 40%, p = 0.04). Additionally, the wireless motility capsule measurements and symptoms were similar between the groups at baseline ( p > 0.05), which have previously been published 21 , 22 . No differences were found between dropouts and replacements and details can be found in the supplementary materials.…”

Section: Resultssupporting

confidence: 68%

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Liraglutide accelerates colonic transit in people with type 1 diabetes and polyneuropathy: A randomised, double‐blind, placebo‐controlled trial

et al. 2020

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Background Glucagon-like peptide-1 receptor agonists, such as liraglutide, reduce hyperglycaemia and induce weight loss and are used as a treatment in diabetes. However, common adverse effects include nausea, loss of appetite and prolonged gastric emptying. It is not known whether these changes are centrally generated or if liraglutide alters the enteric motility. Objective To investigate the effects of liraglutide on gastrointestinal function and symptoms. Methods A total of 48 adults with type 1 diabetes and confirmed distal symmetric polyneuropathy were randomised to receive liraglutide 1.8 mg/day or placebo for 26 weeks. Regional transit times and motility indexes were assessed with a wireless motility capsule, whereas symptoms were evaluated using the validated gastroparesis cardinal symptom index. Results Liraglutide treatment reduced large bowel transit time (31.7%, p = 0.04) and decreased motility index (6.1%, p = 0.04) compared to placebo, whereas the groups did not differ in gastric emptying or small-bowel transit times. Liraglutide increased postprandial fullness with 29% ( p = 0.01). Increased small bowel transit time was associated with decreased bloating ( p = 0.008). Conclusion Liraglutide accelerates large bowel transit and decreases motility index, which may indicate better coordination of propulsive motility. This potentially improves the function of the enteric nervous system, leading to normalised colonic function and positive effects in type 1 diabetes.

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Section: Resultssupporting

confidence: 68%

“…Additionally, the wireless motility capsule measurements and symptoms were similar between the groups at baseline (p > 0.05), which have previously been published. 21,22 No differences were found between dropouts and replacements and details can be found in the supplementary materials.…”

Section: Resultsmentioning

confidence: 99%

Liraglutide accelerates colonic transit in people with type 1 diabetes and polyneuropathy: A randomised, double‐blind, placebo‐controlled trial

et al. 2020

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“…Our study is the first to report intestinal pH alterations in patients with diabetic diarrhoea. Previously, this has been investigated in asymptomatic type 1 diabetic patients with peripheral neuropathy, findings from studies show a decreased colonic pH levels and an increased pH difference across the ileocaecal junction compared to healthy controls [49,50]. Similar findings have been demonstrated in irritable bowel syndrome [24].…”

Section: Discussionsupporting

confidence: 55%

Diabetic diarrhoea: A study on gastrointestinal motility, pH levels and autonomic function

2021

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Background. Chronic diarrhoea is a common, but poorly investigated diabetes complication. Autonomic neuropathy is a leading pathophysiological theory founded on old, small studies. Studies of gastrointestinal motility and pH levels are lacking.Objectives. Using new diagnostic methods, we aimed to find out if diabetic diarrhoea was associated with alterations in gastrointestinal motility, pH levels and autonomic function.Methods. Fifty-seven patients (42 women, 46 with type 1 diabetes) were prospectively included. Symptoms were evaluated with the gastrointestinal symptom rating scale, defining ≥4 points as cases with diarrhoea. Patients scoring <4 were used as controls. We used the wireless motility capsule to measure gastrointestinal transit times, pH levels and contractility parameters. Autonomic function was assessed by measuring heart rate variability, baroreflex sensitivity and orthostatic hypotension.Results. Seventeen patients (30%) had diarrhoea. Compared with controls, cases had slower gastric emptying (21:46 vs. 4:14, h:min, p = 0.03) and faster colonic transit (18:37 vs. 54:25, p < 0.001). Cases had increased intraluminal pH in the antrum (2.4 vs. 1.2, p = 0.009), caecum (7.3 vs. 6.4, p = 0.008) and entire colon (7.1 vs. 6.7, p = 0.05). They also had a decreased pH difference across the pylorus (3.3 vs. 4.9, p = 0.004) and ileocaecal junction (0.6 vs 1.0, p = 0.009). The groups did not differ in autonomic function, but diastolic blood pressure drop correlated r s = −0.34 (p = 0.04) with colonic transit time. Conclusions.Patients with diabetic diarrhoea had altered gastrointestinal transit and intraluminal pH levels, but minimal changes in autonomic function. Our results suggest that tests of gastrointestinal function are clinically useful in diabetic diarrhoea.

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“…By expanding focus beyond the pylorus, recent studies have indeed uncovered a possible link between small bowel dysmotility and symptoms suggestive of gastroparesis . Here, the WMC may play an important role in further research, providing pH and pressure profiles from gut segments otherwise largely unavailable for examination …”

Section: Discussionmentioning

confidence: 99%

“…[37][38][39] Here, the WMC may play an important role in further research, providing pH and pressure profiles from gut segments otherwise largely unavailable for examination. 5,40,41 Nevertheless, as the rate of GE is pivotal in determining postprandial glycaemia, its measurement will still be of great importance in diabetes patients, especially those presenting with unexplained fluctuations in blood glucose levels. 3 Consequently, the latest consensus statement on investigation of gastric motility recommends GE studies to be performed in patients with poorly controlled diabetes.…”

Section: Roc Curvementioning

confidence: 99%

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Sangnes

Søfteland

Bekkelund

et al. 2019

Neurogastroenterology Motil

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Background Gastroparesis is a potentially severe late complication of diabetes mellitus. Today, delayed gastric emptying (GE) is mandatory for establishing the diagnosis. In this study, we compared wireless motility capsule (WMC) with gastric emptying scintigraphy (GES). Methods Seventy‐two patients (49 women) with diabetes mellitus (59 type 1) and symptoms compatible with gastroparesis were prospectively included between 2014 and 2018. Patients were simultaneously examined with GES and WMC. Symptoms were assessed with the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI‐SYM) questionnaire. All patients were on intravenous glucose‐insulin infusion during testing. Key Results WMC and GES correlated r = .74, P < .001. Compared to GES, WMC at ordinary cutoff for delayed GE (300 minutes) had a sensitivity of 0.92, specificity 0.73, accuracy 0.80, and Cohen's kappa κ = 0.61 (P < .001). By receiver operating characteristics (ROC), the area under the curve was 0.95 (P < .001). A cutoff value for delayed GE of 385 minutes produced sensitivity 0.92, specificity 0.83, accuracy 0.86, and Cohen's kappa κ = 0.72 (P < .001). Inter‐rater reliability for GE time with WMC was r = .996, κ = 0.97, both P < .001. There was no difference in symptom severity between patients with normal and delayed GE. Conclusions & Inferences Our findings demonstrate the applicability of WMC as a reliable test to assess gastric emptying in diabetic gastroparesis showing very high inter‐observer correlation. By elevating the cutoff value for delayed emptying from 300 to 385 minutes, we found higher specificity without reducing sensitivity.

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Regional gastrointestinal pH profile is altered in patients with type 1 diabetes and peripheral neuropathy

Abstract: The GI pH profile in T1DM with DSPN is different from healthy subjects. Changes in pH profile may have important therapeutic implications and influence pharmacotherapeutic bioavailability.

Cited by 8 publications

References 51 publications

Liraglutide accelerates colonic transit in people with type 1 diabetes and polyneuropathy: A randomised, double‐blind, placebo‐controlled trial

Liraglutide accelerates colonic transit in people with type 1 diabetes and polyneuropathy: A randomised, double‐blind, placebo‐controlled trial

Diabetic diarrhoea: A study on gastrointestinal motility, pH levels and autonomic function

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

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