Risk factors and early detection of gastroparesis in patients with type 2 diabetes mellitus

Abstract

Nowadays, diabetes mellitus is considered as one of the greatest global problems in internal medicine as it results in multiple organ damage and irreversible changes in the vital functional systems of the body. Unfortunately, there are no statistical data on the prevalence of gastrointestinal autonomic neuropathy in patients with type 2 diabetes mellitus in the Ukrainian population; making an early accurate diagnosis can be a clinical challenge since its manifestations are often considered as the manifestations of other diseases. Multifaceted clinical manifestations of gastroparesis cause difficulties in making a timely diagnosis, which can lead to an unfavourable prognosis. Diabetic gastroparesis symptoms were found in 45.5% of patients with type 2 diabetes mellitus: mild gastroparesis was observed in 29 (18.6%) patients; moderate gastroparesis was seen in 32 (20.5%) subjects; the signs of severe diabetic gastroparesis were present in 10 (6.4%) patients only. According to the assessment of the Neuropathy Disability Score, in patients with type 2 diabetes mellitus (disease duration of more than 10 years) and severe manifestations of polyneuropathy, the presence of risk factors for hypoglycemia as well as cigarette smoking are predictors of the development and progression of diabetic gastroparesis symptoms. They include a positive family history of diabetes mellitus, chronic microvascular complications of diabetes mellitus, concomitant cardiovascular diseases. Diabetes mellitus duration of more than 10 years, severe manifestations of polyneuropathy, increase in the incidence of hypoglycemic episodes as well as cigarette smoking should be considered as risk factors for gastroparesis in type 2 diabetes mellitus. We developed a mathematical model to assess the risk of developing gastroparesis in patients with type 2 diabetes mellitus using the results of a questionnaire (the Gastroparesis Cardinal Symptom Index, the Hypoglycemia Fear Survey-Total), and the Neuropathy Disability Score. For future research into diabetic gastroparesis, we recommend that a multicenter study is performed with an increased sample size because the early detection of delayed gastric emptying in this study was as high as we expected. Importantly, a case study of the complete disease history and questionnaires for the early diagnosis of delayed gastric emptying are required for studying the exact risk factors of autonomic neuropathy of the stomach in patients with type 2 diabetes mellitus.