Aims: Delayed gastric emptying (GE)may have a major effect on the management of diabetic patients by causing upper gastrointestinal symptoms, impaired oral drug absorption and contributing to poor blood sugar control. Although the United Arab Emirates (UAE) has one of the highest prevalence of diabetes in the world, studies focusing on the prevalence of diabetes gastroparesis among these diabetics have never been reported previously. The aim of this study was to investigate gastroparesis among randomly selected Emirati type 1 and type 2 diabetic patients referred to a national diabetes center in the UAE. Methods: The study was designed as a controlled, single-blinded study. Using a standardized ultrasound technique, GE was studied in thirty-one randomly recruited type 1 and type 2 diabetic patients and ten normal healthy volunteers. The gastric emptying rate (GER) was estimated and expressed as the percentage reduction in antral cross-sectional area from 15 to 90 min after the ingestion of a semisolid breakfast meal. Results:In comparison to healthy volunteers, diabetic patients showed overall significantly wider mean values of the fasting as well as the postprandial antral areas. The mean value of GER in these Emirati diabetic patients was estimated at 17%, which was less than half of that in the healthy volunteers (50%). Statistically the difference was highly significant (p< 0.001). Normal gastric emptying was estimated as of GER > 32%. Consequently, 71% (22 of 31) of the diabetic patients in this study had more or less pronounced delays in GER (gastroparesis).Conclusions:The results from the present study indicate a higher prevalence of gastroparesis among randomly selected Emirati type 1 and type 2 diabetic patients, than in any other study previously published around the world. This is in line with previous reports about the high prevalence of diabetes complications among UAE diabetics. A larger study is needed to confirm these results.
KeywordsDiabetes MellitusGastric EmptyingUltrasonographyUnited Arab Emirates
Samsom, M., Vermeijden, J.R., Smout, A.J., et al. (2003) Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms: A Prospective Study in Unselected Diabetic Patients. Diabetes Care, 26, 3116-3122. http://dx.doi.org/10.2337/diacare.26.11.3116
Horowitz, M., Maddox, A.F., Wishart, J.M., Harding, P.E., Chatterton, B.E. and Shearman, D.J. (1991) Relationships between Oesophageal Transit and Solid and Liquid Gastric Emptying in Diabetes Mellitus. European Journal of Nuclear Medicine, 18, 229-234. http://dx.doi.org/10.1007/BF00186645
Wegener, M., Borsch, G., Schaffstein, J., Luerweg, C. and Leverkus, F. (1990) Gastrointestinal Transit Disorders in Patients with Insulin-Treated Diabetes Mellitus. Digestive Diseases, 8, 23-36. http://dx.doi.org/10.1159/000171237
Keshavarzian, A., Iber, F.L. and Vaeth, J. (1987) Gastric Emptying in Patients with Insulin-Requiring Diabetes Mellitus. The American Journal of Gastroenterology, 82, 29-35.
Lyrenas, E.B., Olsson, E.H., Arvidsson, U.C., Orn, T.J. and Spjuth, J.H. (1997) Prevalence and Determinants of Solid and Liquid Gastric Emptying in Unstable Type I Diabetes. Relationship to Postprandial Blood Glucose Concentrations. Diabetes Care, 20, 413-418. http://dx.doi.org/10.2337/diacare.20.3.413
Horowitz, M., O’Donovan, D., Jones, K.L., Feinle, C., Rayner, C.K. and Samsom, M. (2002) Gastric Emptying in Diabetes: Clinical Significance and Treatment. Diabetic Medicine, 19, 177-194. http://dx.doi.org/10.1046/j.1464-5491.2002.00658.x
Horowitz, M. and Fraser, R. (1994) Disordered Gastric Motor Function in Diabetes Mellitus. Diabetologia, 37, 543-551. http://dx.doi.org/10.1007/BF00403371
Shin, A.S. and Camilleri, M. (2013) Diagnostic Assessment of Diabetic Gastroparesis. Diabetes, 62, 2667-2673. http://dx.doi.org/10.2337/db12-1706
Khoo, J., Rayner, C.K., Feinle-Bisset, C., Jones, K.L. and Horowitz, M. (2010) Gastrointestinal Hormonal Dysfunction in Gastroparesis and Functional Dyspepsia. Neurogastroenterology & Motility, 22, 1270-1278. http://dx.doi.org/10.1111/j.1365-2982.2010.01609.x
Punkkinen, J., Färkkilä, M., Mätzke, S., et al. (2008) Upper Abdominal Symptoms in Patients with Type 1 Diabetes: Unrelated to Impairment in Gastric Emptying Caused by Autonomic Neuropathy. Diabetic Medicine, 25, 570-577. http://dx.doi.org/10.1111/j.1464-5491.2008.02428.x
Camilleri, M., Bharucha, A.E. and Farrugia, G. (2011) Epidemiology, Mechanisms, and Management of Diabetic Gastroparesis. Clinical Gastroenterology and Hepatology, 9, 5-12. http://dx.doi.org/10.1016/j.cgh.2010.09.022
Bertin, E., Schneider, N., Abdelli, N., et al. (2001) Gastric Emptying Is Accelerated in Obese Type 2 Diabetic Patients without Autonomic Neuropathy. Diabetes & Metabolism, 27, 357-364.
Horowitz, M., Wishart, J.M., Jones, K.L. and Hebbard, G.S. (1996) Gastric Emptying in Diabetes: An Overview. Diabetic Medicine, 13, S16-S22.
Shyangdan, D.S., Royle, P.L., Clar, C., Sharma, P. and Waugh, N.R. (2010) Glucagon-Like Peptide Analogues for Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis. BMC Endocrine Disorders, 10, 20. http://dx.doi.org/10.1186/1472-6823-10-20
Malik, M., Bakir, A., Abi Saab, B., Roglic, G. and King, H. (2005) Glucose Intolerance and Associated Factors in the Multi-Ethnic Population of the United Arab Emirates: Results of a National Survey. Diabetes Research and Clinical Practice, 69, 188-195. http://dx.doi.org/10.1016/j.diabres.2004.12.005
Saadi, H., Carruthers, S.G., Nagelkerke, N., et al. (2007) Prevalence of Diabetes Mellitus and Its Complications in a Population-Based Sample in Al Ain, United Arab Emirates. Diabetes Research and Clinical Practice, 78, 369-377. http://dx.doi.org/10.1016/j.diabres.2007.04.008
International Diabetes Federation (2003) Diabetes Atlas. 2nd Edition, Brussels.
Winge, K., Rasmussen, D. and Werdelin, L.M. (2003) Constipation in Neurological Diseases. Journal of Neurology, Neurosurgery & Psychiatry, 74, 13-19. http://dx.doi.org/10.1136/jnnp.74.1.13
Darwiche, G., Almér, L.O., Björgell, O., Cederholm, C. and Nilsson, P. (1999) Measurement of Gastric Emptying by Standardized Real-Time Ultrasonography in Healthy Subjects and Diabetic Patients. Journal of Ultrasound in Medicine, 18, 673-682.
Darwiche, G., Björgell, O., Thorsson, O. and Almér, L.O. (2003) Correlation between Simultaneous Scintigraphic and Ultrasonographic Measurement of Gastric Emptying in Patients with Type 1 Diabetes Mellitus. Journal of Ultrasound in Medicine, 22, 459-466.
Calbet, J.A. and MacLean, D.A. (1997) Role of Caloric Content on Gastric Emptying in Humans. The Journal of Physiology, 498, 553-559.
Smout, A.J.P.M. and Akkermans, L.M.A. (1992) Gastro-Oesophageal Reflux Disease. In: Smout, A.J.P.M. and Akkermans, L.M.A., Eds., Normal and Disturbed Motility of the Gastrointestinal Tract, Wrightson Biomedical, Petersfield, 67-86.
Peracchi, M., Gebbia, C., Ogliari, C., et al. (2000) Influence of Caloric Intake on Gastric Emptying of Solids Assessed by 13C-Octanoic Acid Breath Test. Scandinavian Journal of Gastroenterology, 35, 814-818. http://dx.doi.org/10.1080/003655200750023174
Hellström, P.M., Grybäck, P. and Jacobsson, H. (2006) The Physiology of Gastric Emptying. Best Practice & Research Clinical Anaesthesiology, 20, 397-407. http://dx.doi.org/10.1016/j.bpa.2006.02.002
Moragas, G., Azpiroz, F., Pavia, J. and Malagelada, J.R. (1993) Relations among Intragastric Pressure, Postcibal Perception, and Gastric Emptying. American Journal of Physiology, 264, G1112-G1117.
Buysschaert, M., Donckier, J., Dive, A., Ketelslegers, J.M. and Lambert, A.E. (1985) Gastric Acid and Pancreatic Polypeptide Responses to Sham Feeding Are Impaired in Diabetic Subjects with Autonomic Neuropathy. Diabetes, 34, 1181-1185. http://dx.doi.org/10.2337/diab.34.11.1181
Nakamura, T., Takebe, K., Imamura, K., et al. (1994) Decreased Gastric Secretory Functions in Diabetic Patients with Autonomic Neuropathy. The Tohoku Journal of Experimental Medicine, 173, 199-208. http://dx.doi.org/10.1620/tjem.173.199
Undeland, K.A., Hausken, T., Svebak, S., Aanderud, S. and Berstad, A. (1996) Wide Gastric Antrum and Low Vagal Tone in Patients with Diabetes Mellitus Type 1 Compared to Patients with Functional Dyspepsia and Healthy Individuals. Digestive Diseases and Sciences, 41, 9-16. http://dx.doi.org/10.1007/BF02208577
Rathmann, W., Enck, P., Frieling, T. and Gries, F.A. (1991) Visceral Afferent Neuropathy in Diabetic Gastroparesis. Diabetes Care, 14, 1086-1089. http://dx.doi.org/10.2337/diacare.14.11.1086
Krishnan, B., Babu, S., Walker, J., Walker, A.B. and Pappachan, J.M. (2013) Gastrointestinal Complications of Diabetes Mellitus. World Journal of Diabetes, 4, 51-63. http://dx.doi.org/10.4239/wjd.v4.i3.51
Nilsson, P.H. (1996) Diabetic Gastroparesis: A Review. Journal of Diabetes and Its Complications, 10, 113-122. http://dx.doi.org/10.1016/1056-8727(96)00001-3
Horowitz, M., Maddern, G.J., Chatterton, B.E., Collins, P.J., Harding, P.E., Shearman, D.J. (1984) Changes in Gastric Emptying Rates with Age. Clinical Science (London), 67, 213-218.
Bennink, R., Peeters, M., Van den Maegdenbergh, V., et al. (1998) Comparison of Total and Compartmental Gastric Emptying and Antral Motility between Healthy Men and Women. European Journal of Nuclear Medicine, 25, 1293-1299. http://dx.doi.org/10.1007/s002590050298
Córdova-Fraga, T., De la Roca-Chiapas, J.M., Solís, S., et al. (2008) Gender Difference in the Gastric Emptying Measured by Magnetogastrography Using a Semi-Solid Test Meal. Acta Gastroenterologica Latinoamericana, 38, 240-245.
Wright, R.A., Krinsky, S., Fleeman, C., Trujillo, J. and Teague, E. (1983) Gastric Emptying and Obesity. Gastroenterology, 84, 747-751.
Jones, T.F., Lin, Z., Sarosiek, I., Moncure, M. and McCallum, R.W. (2001) Assessment of Gastric Emptying and Myoelectric Activity in the Morbidly Obese Patients. Gastroenterology, 120, A1500.
Naeslund, E. and Hellstroem, M. (1998) Glucagon-Like Peptide-1 in the Pathogenesis of Obesity. Drug News & Perspectives, 11, 92. http://dx.doi.org/10.1358/dnp.1998.11.2.659947