Evaluation of gastric emptying and neuropathy in short- and long-term type-1 diabetes

The aim of this study was to determine the gastric emptying, the autonomic and the sensory neuropathy in diabetic patient groups with different durations. Patients, methods: 17 patients (pts) had shorter, 23 pts had longer type-1 DM. The emptying of the stomach was evaluated by a scintigraphic procedure. Autonomic neuropathy (AN) was assessed by cardiovascular reflex tests. Sensory nerve function was studied with a Neurometer. Results: There was a non-significant tendency of prolonged half-time of gastric emptying (HTE) in longer type-1 DM (93.5±10.1 vs. 67.8±6.7min. p>0.05; long- vs. short-standing DM). The AN score and three reflex tests differed between the groups (AN score: 4.3±0.5 vs. 2.5±0.4, p<0.05; heart rate response to breathing: 12.7±1.5 vs. 19.4±2.2 beats/min. p<0.05; Valsalva ratio: 1.3±0.05 vs. 1.75±0.1, p<0,0001; orthostatic hypotension: 23±3.4 vs. 11±3.7mm Hg, p<0.05). A positive correlation was observed between HTE and the AN score in long-standing DM (r=0.57, p<0.01). The correlations between heart rate response to breathing and HTE (r=–0.57, p<0.01) and between the Valsalva ratio and HTE (r=–0.43, p<0.05) in this group were negative. A positive association was found between the orthostatic hypotension and HTE (r=0.51, p<0.01). The current perception thresholds (CPT) at 2 kHz differed between the groups (CPT at the median nerve: 3.66±0.35 vs. 1.84±0.25 mA, p<0,001; CPT at the peroneal nerve: 5.39±0.71 vs. 3.70±0.68 mA, p<0.05). Conclusions: The impaired gastric emptying was frequently found in pts with long-standing DM and the severe AN exhibited a correlation with the slower gastric motility. These data support the hypothesis, that the most progressive manifestations of neuropathy might be responsible for the development of gastroparesis.