Abstract
Background:Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited.Methods:We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population.Results:Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, (P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia (P = .50).Conclusion:Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings.
Highlights
Gastroparesis is a form of autonomic neuropathy resulting in delayed gastric emptying in the absence of mechanical gastric outlet obstruction.[1]
In an observational 30-year follow up from the Diabetes Control and Complications Trial (DCCT), the Epidemiology of Diabetes Interventions and Complications (EDIC) study demonstrated that individuals with type 1 diabetes (T1D) who had greater dysglycemia exposure were more likely to develop delayed gastric emptying.[19]
Delayed gastric emptying and mismatch between insulin action and food absorption can predispose to hypoglycemia, intentional underestimation, delayed administration or omission of insulin doses is common, resulting in suboptimal long term glycemic control.[1,24,25]
Summary
Gastroparesis is a form of autonomic neuropathy resulting in delayed gastric emptying in the absence of mechanical gastric outlet obstruction.[1] It is estimated that between 20% and 50% of people with type 1 diabetes (T1D) will develop the complication,[2] which is thought to occur as a result of immune dysregulation causing loss of gastric pacemaker cells, fibrosis in muscle layers and loss of enteric nerves in people with diabetes.[3,4] Cardinal symptoms include early satiety, nausea, vomiting and bloating[5] and the associated burden of these symptoms has been shown to have a profound impact on quality of life and healthcare utilization by affected individuals.[1,6] Diagnosis is established by demonstration of delayed gastric emptying and the absence of gastric outlet obstruction using scintigraphy, capsule endoscopy or isotope breath tests in symptomatic individuals. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited
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