Islet Cell Associated Autoantibodies and C-Peptide Levels in Patients with Diabetes and Symptoms of Gastroparesis (original) (raw)
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Delayed Gastric Emptying and Gastric Autoimmunity in Type 1 Diabetes
Diabetes Care, 2002
OBJECTIVE—Delayed gastric emptying and/or gastrointestinal symptoms occur in 30–50% of diabetic patients. Known contributing factors are autonomic neuropathy and acute hyperglycemia, but the role of gastric autoimmunity has never been investigated, although 15–20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs). We studied gastric motility in diabetes in relation to PCA status, autonomic nerve function, HbA1c, thyroid-stimulating hormone (TSH), Helicobacter pylori (HP), acid production, and gastric histology. RESEARCH DESIGN AND METHODS—Gastric emptying of solids and liquids (measured by 13C-octanoic acid and 13C-glycine breath tests, respectively) was tested in euglycemic conditions in 42 type 1 diabetic patients (male/female: 29/13; 15 PCA+; mean age 40 ± 15 years; mean HbA1c 7.8 ± 0.9%). Gastrointestinal symptoms, autonomic nerve function (Ewing tests), PCA status (indirect immunofluorescence), gastric histology, and acid secretion (pentagastrin) were assessed...
Risk factors and early detection of gastroparesis in patients with type 2 diabetes mellitus
Regulatory mechanisms in biosystems, 2019
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.
Cureus
Background The symptoms of gastroparesis, such as bloating, postprandial fullness, early satiety, nausea, and abdominal discomfort, progressively worsen the quality of life of the affected individuals. The diagnosis is established on the assessment of gastric function that confirms delayed gastric emptying in the absence of structural etiologies. This study aimed to detect gastroparesis-related clinical symptoms early in patients with type 2 diabetes mellitus (T2DM), investigate the concomitant risk factors, and evaluate the prevalence.
The Journal of Clinical Endocrinology & Metabolism, 1999
Previous studies have shown a high prevalence of gastric parietal cell antibodies (PCA) in type 1 diabetes, which can be accompanied by (sub)clinical autoimmune gastric disease. This study aimed to determine the grade of associated autoimmunity and to assess the pattern of prevalence of PCA by gender, age, duration of disease, age at onset of diabetes, and human leukocyte antigen (HLA) type in an adult type 1 diabetic population. Furthermore, to examine the clinical significance of being PCA positive, manifestations of gastric autoimmune disease were studied in PCA-positive and PCA-negative patients.
Prevalence of Gastroparesis in Type 1 Diabetes Mellitus and its Relationship to Dyspeptic Symptoms
2010
Background and Aim: Gastroparesis and/or dyspeptic symptoms occur in around 50% of type 1 diabetic patients. The aim of our study was to evaluate the prevalence of gastroparesis in patients with type 1 diabetes using 13 Coctanoic acid breath test ( 13 C-OBT) and the relationship between dyspeptic symptoms and gastric emptying. Methods: Gastric emptying of solids was evaluated prospectively in euglycemic conditions in 69 type 1 diabetic patients (male/female: 36/33; mean age 49.5 ± 14.2 years; mean duration of diabetes 20.4 ± 8.2 years) and 40 healthy volunteers (male/female 17/23; mean age 34.3 ± 16 years) using 13 C-OBT. Dyspeptic symptoms, autonomic nerve function and Helicobacter pylori (H. pylori) status were assessed. Results: Solid gastric emptying was slower in diabetic patients (T1/2=125.36 ± 31.5min) than in healthy subjects (T1/2=88.5 ± 27.3 min) (p<0.05). Gastric emptying was slower in diabetic female compared to diabetic male patients (p<0.05). Body mass index (BMI) was the only independent predictor for delayed solid gastric emptying in a logistic regression model testing HbA1c, BMI, age, diabetes duration, H. pylori status, peripheral neuropathy, retinopathy, nephropathy, and autonomic neuropathy. Abdominal bloating and upper abdominal pain were associated with delayed gastric emptying. Conclusions: We found that 33.7% of type 1 diabetic patients had delayed gastric emptying that correlated with female gender, increased BMI, abdominal bloating and upper abdominal pain.
Prevalence of symptoms suggestive of gastroparesis in a cohort of patients with diabetes mellitus
Journal of Diabetes and its Complications, 2013
To estimate the prevalence of symptoms suggestive of gastroparesis and their association to clinical and demographic data in a large population of patients with diabetes mellitus and in the general population in Israel. Methods: A cross-sectional survey of type 2 diabetic patients treated in community settings was performed. All patients and controls completed a demographic questionnaire as well as the Gastroparesis Cardinal Symptom Index (GCSI). Data regarding disease duration, medications, complications, recent blood glucose and HbA1C levels, were also collected. Results: A total of 382 patients and 88 healthy volunteers were included. Patients and controls were aged 63.07 ± 10.63 and 58.69 ± 10.73 years respectively with a BMI of 30.45 ± 8.15 and 25.64 ± 4.25 kg/m 2 respectively. Compared to controls, more patients with diabetes complained of nausea (24.8% vs. 4.5%, p b 0.0001), post-prandial fullness (44.6% vs. 26.1%, p = 0.001), bloating (48.8% vs. 36.4%, p = 0.035) and stomach or belly visibly larger after a meal (53% vs. 29.5%, p b 0.0001). In multivariate analysis, symptoms were associated with female sex, BMI, blood glucose, HbA1C, metformin treatment and disease duration. Conclusions: The prevalence of symptoms suggestive of gastroparesis among patients with diabetes mellitus in Israel is high and is independently associated with female sex and metformin therapy.
Frontiers in Immunology
The presence of islet autoantibodies and islet reactive T cells (T+) in adults with established type 2 diabetes (T2D) have been shown to identify those patients with more severe β-cell dysfunction. However, at what stage in the progression toward clinical T2D does islet autoimmunity emerge as an important component influencing β-cell dysfunction? In this ancillary study to the Restoring Insulin SEcretion (RISE) Study, we investigated the prevalence of and association with β-cell dysfunction of T+ and autoantibodies to the 65 kDa glutamic acid decarboxylase antigen (GADA) in obese pre-diabetes adults with impaired glucose tolerance (IGT) and recently diagnosed treatment naïve (Ndx) T2D. We further investigated the effect of 12 months of RISE interventions (metformin or liraglutide plus metformin, or with 3 months of insulin glargine followed by 9 months of metformin or placebo) on islet autoimmune reactivity. We observed GADA(+) in 1.6% of NdxT2D and 4.6% of IGT at baseline, and in 1...
2018
Background: Autoimmune gastritis and pernicious anemia (PA) are common autoimmune disorders, being present in up to 2% of the general population. However, in patients with type 1 diabetes (DM1) or autoimmune thyroid disease, the prevalence is 3-to 5-fold. Autoimmune atrophic gastritis (AAG) is characterized by: 1) atrophy of the corpus and fundus; 2) autoantibodies to the parietal cell (PC) and to the intrinsic factor (IF); 3) achlorhydria; 4) iron deficiency anemia; 5) hypergastrinemia; 6) vitamin-B12 deficiency leading to PA; 7) in up to 10% of the patients, AAG may predispose to gastric cancer (GC) or carcinoid tumours. In addition to autoimmune disease, Helicobacter pylori (HP)-infection is the other important causative agent of atrophic gastritis (AG), and now suspected to be a trigger of AAG as well. The high prevalence of AAG in DM1 and its potentially serious consequences provide a strong rationale for screening, early diagnosis, periodic surveillance by gastroscopy, and treatment. Whether regular gastroscopic surveillance is needed in patients with AAG/PA is controversial. To obviate the need for invasive diagnostic methods (gastroscopy) for these conditions, Biohit Oyj (Helsinki, Finland) launched several years ago an ELISA-based assay designed to measure the concentrations of four stomach-specific biomarkers (Pepsinogen I, Pepsinogen II, Gastrin-17, H. pylori IgG antibodies) from a single blood sample. This GastroPanel ® test is the first non-invasive diagnostic tool for stomach health (testing both the structure and function). The new-generation Unified GastroPanel ® is a technically advanced version of this test, where the processing conditions of all biomarkers are uniform, making the test more versatile. Objective: To conduct a systematic GastroPanel ® screening of DM1 patients to establish the prevalence of AAG and its associated risks (PA included). Another objective is to assess the utility of this non-invasive serum biomarker test as a substitute to gastroscopy in the systematic monitoring of the DM1 patients for AAG and its severe clinical sequels.