Gastrointestinal autonomic neuropathy in diabetes: the unattended borderline between diabetology and gastroenterology

Kempler, Péter; Várkonyi, Tamás; Körei, Anna Erzsébet; Horváth, Viktor J.

doi:10.1007/s00125-015-3826-y

Cited by 16 publications

(13 citation statements)

References 13 publications

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“…Slower gastric emptying mainly as a consequence of a parasympathetic involvement develops during the progression of diabetic neuronal damage ( 32 ). Gastroparesis in AN is considered as the underlying mechanism in patients with unexplained periods of hypoglycemia followed by hyperglycemia ( 33 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Autonomic Neuropathy and Glucose Variability in Patients With Type 1 Diabetes: Is There an Association?

et al. 2018

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IntroductionThe oxidative stress associated with glucose variability might be responsible for neuronal damage while autonomic neuropathy (AN) has a detrimental effect on metabolism. The aim of the study was to find relationship between AN and GV in type 1 diabetic patients and to identify further factors that affect GV.Patients and methodsTwenty type 1 diabetic patients were involved (age: 39.5 ± 3.4 years, duration of diabetes: 17.5 ± 2.5 years; HbA1c: 8.1 ± 0.2%, mean ± SE). AN was assessed by the cardiovascular reflex tests. The interstitial glucose levels were determined following insertion of a subcutaneous electrode during the continuous glucose monitoring (CGM) method on six consecutive days. GV was characterized by calculation of four parameters.ResultsSD of interstitial glucose values correlated positively with the overall AN score and the degree of the orthostatic reduction of systolic blood pressure (AN-score-SD ρ = 0.47, p < 0.05; orthostasis-SD: ρ = 0.51, p < 0.05). Mean absolute glucose (MAG) correlated with three parameters of AN (AN-score-MAG: ρ = 0.62, p < 0.01; 30/15 ratio-MAG: ρ = −0.50, p < 0.05; orthostasis-MAG: ρ = 0.59, p < 0.01). The HbA1c also correlated with two parameters of GV (HbA1c-continuous overlapping net glycemic action: ρ = 0.56, p < 0.05; HbA1c-MAG: ρ = 0.45, p < 0.05). The frequency of hypoglycemia did not exhibit any correlation with measures of GV.ConclusionSeverity of glucose variability but not overall glucose load correlates with both parasympathetic and sympathetic dysfunctions in type 1 diabetes. Higher HbA1c is associated with more severe glucose variability. The observed correlation between increased glucose variability and the severity of AN necessitates the further exploration of this relationship.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Autonomic Neuropathy and Glucose Variability in Patients With Type 1 Diabetes: Is There an Association?

et al. 2018

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“…Although the most frequently identified gastrointestinal complication of diabetes is gastroparesis [8], which can itself exert a negative impact on the patient's glycaemic control and quality of life, gastrointestinal manifestations remain underrecognised [9]. Over a 10-year period, the cumulative HR for developing gastroparesis, relative to healthy controls, is 33 (95% CI 2, 274) in patients with type 1 diabetes in contrast to 7.5 (95% CI 0.8, 68) in those with type 2 diabetes [10].…”

Section: Introductionmentioning

confidence: 99%

Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered caecal pH profile

et al. 2017

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“…A betegnek semmilyen emésztőszervi panasza sem volt az extrém lassú gyomorürülés ellenére sem, ami arra utal, hogy halmozottan hypoglykaemiás betegben panaszmentesen is igazolhatunk lassult gyomorürülést. 27 A szövetiglukóz-monitorozás a felvételt követően egyértelművé tette a naponta ismétlődő, konzekvens reggeli és esti postprandialis hpyoglykaemia-hajlamot, amely reggeli után volt kifejezettebb. A beteg konvulzív rosszullétei is általában koradélelőtt voltak felvétele előtt.…”

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Ismétlődő súlyos hypoglykaemiákhoz vezető neuropathia pancreatogen diabeteses betegben (esetismertetés)

Nyiraty¹,

Fehértemplomi²,

Orosz³

et al. 2017

Diabetologia Hungarica

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A szerzők ismertetik a szénhidrátanyagcsere-variabilitás fogalmát és annak hátrányos következményeit, amelyek közül kiemelik az ismétlődő hypoglykaemiák kockázatának növekedését. Részletesen foglalkoznak azokkal a kóroktani tényezőkkel, amelyek magyarázzák az autonóm neuropathia szerepét a súlyos hypoglykaemia kialakulásában. Elemzik a gyomorürülés lassulásának és a pancreas exokrin funkciójának szerepét a kóros vércukoresés létrejöttében. Esetismertetésük során bemutatják egy visszatérően súlyos hypoglykemiákat elszenvedő pancreatogen diabeteses beteg esetén végzendő diagnosztikus tevékenységet és a terápiás lehetőségeket. A beteg adataiból és a kórkép követésének tapasztalataiból általános érvényű összefoglaló következetéseket vonnak le a pancreatogen diabetesben megfigyelhető, súlyos neuropathia és felszívódási zavar miatt kialakuló hypoglykaemia ismérveiről. ■ Kulcsszavak: hypoglykaemia, autonóm neuropathia, gastroparesis, pancreatogen diabetes Recurrent hypoglycemias caused by neuropathy in a patient with pancreatogenic diabetes. A case report Summary: The authors define the meaning of glycemic variability and the possible detrimental consequences including the increased risk of recurrent hypoglycemias. They describe the details of the role of autonomic neuropathy in the pathogenesis of severe hypoglycemia. Slower gastric emptying and impaired exocrine function are analyzed as pathogenetic factors of abnormally low glucose values. A case history demonstrates the diagnostic steps and therapeutic options of a patient with pancreatogenic diabetes and recurrent hypoglycemias. Rewieving the patient's data and the details of follow-up they draw general conclusions about the characteristics of the hypoglycemia detected in pancreatogenic diabetes associated with autonomic neuropathy and impaired intestinal absorption.

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Gastrointestinal autonomic neuropathy in diabetes: the unattended borderline between diabetology and gastroenterology

Cited by 16 publications

References 13 publications

Cardiovascular Autonomic Neuropathy and Glucose Variability in Patients With Type 1 Diabetes: Is There an Association?

Cardiovascular Autonomic Neuropathy and Glucose Variability in Patients With Type 1 Diabetes: Is There an Association?

Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered caecal pH profile

Ismétlődő súlyos hypoglykaemiákhoz vezető neuropathia pancreatogen diabeteses betegben (esetismertetés)

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