Satiety testing in diabetic gastroparesis: Effects of insulin pump therapy with continuous glucose monitoring on upper gastrointestinal symptoms and gastric myoelectrical activity

the NIDDK Gastroparesis Clinical Research Consortium

Research output: Contribution to journalArticle

Abstract

Background: Symptoms induced by caloric or non-caloric satiety test meals and gastric myoelectrical activity (GMA) have not been studied in patients with diabetic gastroparesis (DGP) before and after intense glucose management. Aims: We determined the effects of continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) on GI symptoms, volume consumed, and GMA induced by the caloric meal satiety test (CMST) and water load satiety test (WLST) in DGP. Methods: Forty-five patients with DGP underwent CMST and WLST at baseline and 24 weeks after CSII with CGM. Subjects ingested the test meals until they were completely full. Visual analog scales were used to quantify pre- and postmeal symptoms, and GMA was recorded with cutaneous electrodes and analyzed visually and by computer. Key Results: At baseline and 24-week visits, nausea, bloating, abdominal discomfort, and fullness were immediately increased after CMST and WLST (Ps < 0.01). The meal volumes ingested were significantly less than normal controls at both visits in almost one-third of the subjects. After the CMST, the percentage 3 cycle per minute GMA increased and bradygastria decreased compared with WLST (Ps < 0.05). After treatment for 24 weeks meal volumes ingested, postmeal symptoms and GMA were no different than baseline. Conclusions and inferences: (a) Satiety test meals elicited symptoms of nausea, bloating, and abdominal discomfort; (b) CMST stimulated more symptoms and changes in GMA than WLST; and (c) CSII with CGM for 24 weeks did not improve symptoms, volumes ingested, or GMA elicited by the two satiety test meals in these patients with diabetic GP. Satiety tests in diabetic gastropresis are useful to study acute postprandial symptoms and GMA, but these measures were not improved by intensive insulin therapy.

Original languageEnglish (US)
Article numbere13720
JournalNeurogastroenterology and Motility
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Gastroparesis
Meals
Stomach
Insulin
Glucose
Subcutaneous Infusions
Water
Therapeutics
Nausea
Visual Analog Scale
Electrodes

Keywords

  • caloric and non-caloric test meals
  • diabetic gastroparesis
  • gastric dysrhythmias
  • gastric myoelectrical activity
  • gastroparesis cardinal symptom index
  • patient assessment of upper GI symptoms

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

@article{bf9b0edb3f684b6f992e706248d652b3,
title = "Satiety testing in diabetic gastroparesis: Effects of insulin pump therapy with continuous glucose monitoring on upper gastrointestinal symptoms and gastric myoelectrical activity",
abstract = "Background: Symptoms induced by caloric or non-caloric satiety test meals and gastric myoelectrical activity (GMA) have not been studied in patients with diabetic gastroparesis (DGP) before and after intense glucose management. Aims: We determined the effects of continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) on GI symptoms, volume consumed, and GMA induced by the caloric meal satiety test (CMST) and water load satiety test (WLST) in DGP. Methods: Forty-five patients with DGP underwent CMST and WLST at baseline and 24 weeks after CSII with CGM. Subjects ingested the test meals until they were completely full. Visual analog scales were used to quantify pre- and postmeal symptoms, and GMA was recorded with cutaneous electrodes and analyzed visually and by computer. Key Results: At baseline and 24-week visits, nausea, bloating, abdominal discomfort, and fullness were immediately increased after CMST and WLST (Ps < 0.01). The meal volumes ingested were significantly less than normal controls at both visits in almost one-third of the subjects. After the CMST, the percentage 3 cycle per minute GMA increased and bradygastria decreased compared with WLST (Ps < 0.05). After treatment for 24 weeks meal volumes ingested, postmeal symptoms and GMA were no different than baseline. Conclusions and inferences: (a) Satiety test meals elicited symptoms of nausea, bloating, and abdominal discomfort; (b) CMST stimulated more symptoms and changes in GMA than WLST; and (c) CSII with CGM for 24 weeks did not improve symptoms, volumes ingested, or GMA elicited by the two satiety test meals in these patients with diabetic GP. Satiety tests in diabetic gastropresis are useful to study acute postprandial symptoms and GMA, but these measures were not improved by intensive insulin therapy.",
keywords = "caloric and non-caloric test meals, diabetic gastroparesis, gastric dysrhythmias, gastric myoelectrical activity, gastroparesis cardinal symptom index, patient assessment of upper GI symptoms",
author = "{the NIDDK Gastroparesis Clinical Research Consortium} and Koch, {Kenneth L.} and Hasler, {William L.} and {Van Natta}, Mark and Jorge Calles-Escandon and Madhusudan Grover and Pasricha, {Pankaj J.} and Snape, {William J.} and Parkman, {Henry P.} and Abell, {Thomas L.} and McCallum, {Richard W.} and Nguyen, {Linda A.} and Irene Sarosiek and Gianrico Farrugia and James Tonascia and Linda Lee and Laura Miriel and Frank Hamilton",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/nmo.13720",
language = "English (US)",
journal = "Neurogastroenterology and Motility",
issn = "1350-1925",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Satiety testing in diabetic gastroparesis

T2 - Effects of insulin pump therapy with continuous glucose monitoring on upper gastrointestinal symptoms and gastric myoelectrical activity

AU - the NIDDK Gastroparesis Clinical Research Consortium

AU - Koch, Kenneth L.

AU - Hasler, William L.

AU - Van Natta, Mark

AU - Calles-Escandon, Jorge

AU - Grover, Madhusudan

AU - Pasricha, Pankaj J.

AU - Snape, William J.

AU - Parkman, Henry P.

AU - Abell, Thomas L.

AU - McCallum, Richard W.

AU - Nguyen, Linda A.

AU - Sarosiek, Irene

AU - Farrugia, Gianrico

AU - Tonascia, James

AU - Lee, Linda

AU - Miriel, Laura

AU - Hamilton, Frank

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Symptoms induced by caloric or non-caloric satiety test meals and gastric myoelectrical activity (GMA) have not been studied in patients with diabetic gastroparesis (DGP) before and after intense glucose management. Aims: We determined the effects of continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) on GI symptoms, volume consumed, and GMA induced by the caloric meal satiety test (CMST) and water load satiety test (WLST) in DGP. Methods: Forty-five patients with DGP underwent CMST and WLST at baseline and 24 weeks after CSII with CGM. Subjects ingested the test meals until they were completely full. Visual analog scales were used to quantify pre- and postmeal symptoms, and GMA was recorded with cutaneous electrodes and analyzed visually and by computer. Key Results: At baseline and 24-week visits, nausea, bloating, abdominal discomfort, and fullness were immediately increased after CMST and WLST (Ps < 0.01). The meal volumes ingested were significantly less than normal controls at both visits in almost one-third of the subjects. After the CMST, the percentage 3 cycle per minute GMA increased and bradygastria decreased compared with WLST (Ps < 0.05). After treatment for 24 weeks meal volumes ingested, postmeal symptoms and GMA were no different than baseline. Conclusions and inferences: (a) Satiety test meals elicited symptoms of nausea, bloating, and abdominal discomfort; (b) CMST stimulated more symptoms and changes in GMA than WLST; and (c) CSII with CGM for 24 weeks did not improve symptoms, volumes ingested, or GMA elicited by the two satiety test meals in these patients with diabetic GP. Satiety tests in diabetic gastropresis are useful to study acute postprandial symptoms and GMA, but these measures were not improved by intensive insulin therapy.

AB - Background: Symptoms induced by caloric or non-caloric satiety test meals and gastric myoelectrical activity (GMA) have not been studied in patients with diabetic gastroparesis (DGP) before and after intense glucose management. Aims: We determined the effects of continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) on GI symptoms, volume consumed, and GMA induced by the caloric meal satiety test (CMST) and water load satiety test (WLST) in DGP. Methods: Forty-five patients with DGP underwent CMST and WLST at baseline and 24 weeks after CSII with CGM. Subjects ingested the test meals until they were completely full. Visual analog scales were used to quantify pre- and postmeal symptoms, and GMA was recorded with cutaneous electrodes and analyzed visually and by computer. Key Results: At baseline and 24-week visits, nausea, bloating, abdominal discomfort, and fullness were immediately increased after CMST and WLST (Ps < 0.01). The meal volumes ingested were significantly less than normal controls at both visits in almost one-third of the subjects. After the CMST, the percentage 3 cycle per minute GMA increased and bradygastria decreased compared with WLST (Ps < 0.05). After treatment for 24 weeks meal volumes ingested, postmeal symptoms and GMA were no different than baseline. Conclusions and inferences: (a) Satiety test meals elicited symptoms of nausea, bloating, and abdominal discomfort; (b) CMST stimulated more symptoms and changes in GMA than WLST; and (c) CSII with CGM for 24 weeks did not improve symptoms, volumes ingested, or GMA elicited by the two satiety test meals in these patients with diabetic GP. Satiety tests in diabetic gastropresis are useful to study acute postprandial symptoms and GMA, but these measures were not improved by intensive insulin therapy.

KW - caloric and non-caloric test meals

KW - diabetic gastroparesis

KW - gastric dysrhythmias

KW - gastric myoelectrical activity

KW - gastroparesis cardinal symptom index

KW - patient assessment of upper GI symptoms

UR - http://www.scopus.com/inward/record.url?scp=85073959178&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073959178&partnerID=8YFLogxK

U2 - 10.1111/nmo.13720

DO - 10.1111/nmo.13720

M3 - Article

C2 - 31574209

AN - SCOPUS:85073959178

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

SN - 1350-1925

M1 - e13720

ER -