Early Gastrointestinal Neuropathy Assessed by Wireless Motility Capsules in Adolescents with Type 1 Diabetes

Abstract

Background: To assess the prevalence of objective signs of gastrointestinal (GI) autonomic neuropathy (AN) in adolescents with type 1 diabetes (T1D). In addition, to investigate associations between objective GI findings and self-reported symptoms or other findings of AN. Methods: Fifty adolescents with T1D and 20 healthy adolescents were examined with a wireless motility capsule to assess the total and regional GI transit times and motility index. GI symptoms were evaluated with the GI Symptom Rating Scale questionnaire. AN was evaluated with cardiovascular and quantitative sudomotor axon reflex tests. Results: There was no difference in GI transit times in adolescents with T1D and healthy controls. Adolescents with T1D had a higher colonic motility index and peak pressure than the controls, and GI symptoms were associated with low gastric and colonic motility index (all p < 0.05). Abnormal gastric motility was associated with the duration of T1D, while a low colonic motility index was inversely associated with “time in target range” for blood glucose (all p < 0.01). No associations were found between signs of GI neuropathy and other measures of AN. Conclusions: Objective signs of GI neuropathy are common in adolescents with T1D and it seems to require early interventions in patients at high risk of developing GI neuropathy.

Cross-sectional study investigating the association between inflammatory biomarkers and neuropathy in adolescents with type 1 diabetes

“…Both cytokines, like TNF-a and IL-6 and high blood glucose levels could potentially impact various physiological processes, including those related to peristalsis and metabolism. In our cohort, we have shown that a low colonic motility index was inversely associated with ‘time in target range’ for blood glucose, 14 however, drawing a direct link between the association of TNF-a, IL-6 and GI motility as a surrogate for high blood glucose effects would require further research and investigation.…”

Sweat gland nerve fiber density and association with sudomotor function, symptoms, and risk factors in adolescents with type 1 diabetes

“…Another limitation of our study is that we had no information about diet, because nutrition is known to impact sweating [ 35 ]. However, on the test day, they received the same standard meal as part of another test [ 13 ], which might have minimized this factor. Finally, the test only evaluates the SG innervation at the exact spot where the skin biopsy was taken.…”

“…Study participants were from the T1DANES cohort (T1D = type 1 diabetes, D = Danish population, A = adolescents, N = neuropathy, ES = explanatory study). All participants underwent additional neurological examinations not described in this paper [ 12 , 13 ].…”