Relationship between clinical features and gastric emptying disturbances in diabetes mellitus

Gastric emptying (GE) may be delayed or rapid in diabetes mellitus. We sought to ascertain differences in risk factors or associated features (i.e. diabetic 'phenotype') among patients with diabetes who have rapid, slow or normal GE. From a database of patients in whom gastrointestinal transit was assessed by scintigraphy, we compared the diabetic phenotype in diabetic patients with rapid, slow and normal GE. Of 129 patients, 55 (42%) had normal, 46 (36%) had delayed and 28 (22%) patients had rapid GE. In each GE category, there was an approximately equal number of type 1 and type 2 diabetes. In multivariable analyses, significant weight loss (OR, 2.81; 95% CI, 1.09-7.23) and neuropathy (OR, 3.60; 95% CI, 1.007-12.89) were the risk factors for delayed and rapid GE, respectively. Insulin therapy (OR, 0.08; 95% CI, 0.01-0.53) was associated with a lower risk of rapid compared to normal GE. However, other manifestations or characteristics of the diabetes 'phenotype' (i.e. type and duration of diabetes, glycosylated haemoglobin levels, and extraintestinal complications) were not useful for discriminating normal from delayed or rapid GE. At a specificity of 60%, clinical features were 73% sensitive for discriminating between normal and delayed GE and 80% sensitive for discriminating normal from rapid GE. Diabetes is associated with slow and rapid GE. Because the diabetic phenotype is of limited utility for identifying disordered GE, GE should be assessed in patients with diabetes and gastrointestinal symptoms.