Mo1294 Diabetic Patients' Perceptions Regarding the Impact of Gastroparesis on Diabetes Control

Abstract

Gastroparesis is a complication of diabetes mellitus. Gastroparetic symptoms of nausea, vomiting, and early satiety and the delayed gastric emptying can make glucose control difficult. The impact of gastroparesis on diabetes management and control from the patient perspective has not been systematically studied. The aim of this study was to identify patient perceptions regarding the impact of gastroparesis on managing their diabetes. Methods: Diabetic patients being referred for gastroparesis and having delayed gastric emptying on gastric scintigraphy were enrolled in this prospective study. Clinical and demographic characteristics were obtained by interview, medical record and laboratory reports. Gastroparetic symptom severity was assessed with the Patient Assessment of Upper GI Symptoms (PAGI-SYM) on a none (0) to very severe (5) scale. A questionnaire developed for this study examined the impact on gastroparesis on diabetes related symptoms and control, with responses ranging from strongly disagree (-2) to strongly agree (+2). Results: 33 individuals with diabetic gastroparesis (25 T1DM and 8 T2DM; average age 44±3 (SEM) years; 26 females) participated. All but 3 patients were taking insulin. Mean HgbA1c was 8.1±0.2% with range from 6.6 to 11.2%. Gastric retention at 4 hrs averaged 37±4% (normal<10%). Duration of diabetes averaged 18.5±2.0 years and gastroparetic symptoms 5.6±1.7 years. Patients rated their most severe symptoms of gastroparesis as nausea (3.7±0.2), early satiety (3.7±0.2), and postprandial fullness (3.8±0.2). Patients with T1DM had greater gastric retention (41±4 vs 23±4% retention at 4 hrs; p<0.05), greater HgbA1c (8.4±1.7 vs 6.3±0.9; p=0.06), and greater vomiting severity (2.7±0.4 vs 0.9±0.6; p=0.03) than patients with T2DM. The majority of diabetic subjects identified that since their diagnosis of gastroparesis, their diabetes was more difficult to control (23 of 33 patients) and that extra time and effort for care of their diabetes was required (22 of 33). In contrast to T2DM, patients with T1DM expressed that since developing gastroparesis, their blood sugars have been higher (0.7±0.3 vs 0.0±0.5; p=0.20), have had more frequent episodes of hypoglycemia (0.6±0.2 vs -0.6±0.4; p<0.01), and found their gastroparetic symptoms worsened with if blood sugars were too high (0.8±0.2 vs 0.1±0.5; p=0.10). Few diabetic patients of either group (7 of 33) felt that their gastroparesis symptoms improved if blood sugars were controlled. Conclusions: Gastroparesis has a significant impact on patients' perceived ability to self-manage and control their diabetes. T1DMpatients, in particular, associate their gastroparesis with episodes of hyperand hypo-glycemia, and find their gastroparetic symptoms worsen with poor control. Future research should focus on strategies to support patient self-management for diabetics with gastroparesis.