The PanGut-study: Evoked potentials following rectal balloon distention, a way of evaluating diabetic autonomic neuropathy in the gut?

Meling, Sondre; Tjora, Erling; Eichele, Heike; Nedergaard, Rasmus Bach; Ejskjær, Niels; Brock, Christina; Søfteland, Eirik

doi:10.1016/j.jdiacomp.2023.108452

Cited by 2 publications

(8 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neuronal phenotyping results have been previously published, but are summarily presented, as they are needed for further analyses in the present paper. 17 …”

Section: Resultsmentioning

confidence: 99%

“…We have previously reported and discussed the findings of rectal hyposensitivity in early stages of diabetes, indicating early onset of visceral hyposensitivity in the gut wall, supporting the presence of distorted neuronal transmission. 17 …”

Section: Discussionmentioning

confidence: 99%

“…The equipment and protocol are based on recent studies and have previously been described in more detail. 15 , 16 , 17 Figure 1 shows the setup for the examination. A rectal balloon was placed 15 cm above the anal verge.…”

Section: Methodsmentioning

confidence: 99%

“…Neuronal phenotyping results have been previously published, but are summarily presented, as they are needed for further analyses in the present paper. 17 Participants with diabetes showed rectal hyposensitivity, evident as higher pressure needed to elicit earliest sensation:…”

Section: Between-group Differencesmentioning

confidence: 99%

See 3 more Smart Citations

Rectal sensitivity correlated with gastrointestinal‐mediated glucose disposal, but not the incretin effect

Meling,

Tjora,

Eichele

et al. 2023

Endocrino Diabet & Metabol

Self Cite

View full text Add to dashboard Cite

ObjectiveThe mechanisms behind the diminished incretin effect in type 2 diabetes are uncertain, but impaired vagal transmission has been suggested. We aimed to investigate the association between the incretin effect and autonomic neuropathy, and the degree of dysglycaemia and duration of diabetes.Design and MethodsFor a cross‐sectional study, we included participants with either longstanding type 2 diabetes, recent onset, untreated diabetes and controls without diabetes matched for age, sex and body mass index. Autonomic nerve function was assessed with cardiovascular reflex tests, heart rate variability and sudomotor function. Visceral afferent nerves in the gut were tested performing rapid rectal balloon distention. An oral glucose tolerance test and an intravenous isoglycaemic glucose infusion were performed to calculate the incretin effect and gastrointestinal‐mediated glucose disposal (GIGD).ResultsSixty‐five participants were recruited. Participants with diabetes had rectal hyposensitivity for earliest sensation (3.7 ± 1.1 kPa in longstanding, 4.0 ± 1.3 in early), compared to controls (3.0 ± 0.9 kPa), p = .005. Rectal hyposensitivity for earliest sensation was not associated with the incretin effect (rho = −0.204, p = .106), but an association was found with GIGD (rho −0.341, p = .005). Incretin effect and GIGD were correlated with all glucose values, HbA1c and duration of diabetes.ConclusionsRectal hyposensitivity was uncovered in both longstanding and early type 2 diabetes, and was not associated with the incretin effect, but with GIGD, implying a potential link between visceral neuropathy and gastrointestinal handling of glucose. Both the incretin effect and GIGD were associated with the degree of dysglycaemia and the duration of diabetes.Previously PublishedSome of the data have previously been published and presented as a poster on the American Diabetes Association 83rd Scientific Sessions: Meling et al; 1658‐P: Rectal Hyposensitivity, a Potential Marker of Enteric Autonomic Nerve Dysfunction, Is Significantly Associated with Gastrointestinally Mediated Glucose Disposal in Persons with Type 2 Diabetes. Diabetes 20 June 2023; 72 (Supplement_1): 1658–P. https://doi.org/10.2337/db23‐1658‐P.

show abstract

“…Neuronal phenotyping results have been previously published, but are summarily presented, as they are needed for further analyses in the present paper. 17 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Between-group Differencesmentioning

confidence: 99%

See 2 more Smart Citations

Rectal sensitivity correlated with gastrointestinal‐mediated glucose disposal, but not the incretin effect

Meling,

Tjora,

Eichele

et al. 2023

Endocrino Diabet & Metabol

Self Cite

View full text Add to dashboard Cite

show abstract

“…The equipment and protocol are described in detail elsewhere [ 14 – 17 ]. Electroencephalography (EEG) was recorded using a 64-channel extended 10-20 montage with reference electrode Fz.…”

Section: Methodsmentioning

confidence: 99%

The Composite Autonomic Symptom Score 31 Questionnaire: A Sensitive Test to Detect Risk for Autonomic Neuropathy

Meling,

Tjora,

Eichele

et al. 2023

Journal of Diabetes Research

Self Cite

View full text Add to dashboard Cite

Background and Aims. Autonomic neuropathy is a common but often neglected complication of diabetes, prediabetes, and even in individuals with an elevated risk of diabetes. The Composite Autonomic Symptom Score (COMPASS) 31 is a validated and easy-to-use questionnaire regarding autonomic symptoms. We aimed to use a digitally, Norwegian version of the COMPASS 31 in people with different durations of diabetes and healthy controls to consider feasibility and to investigate if scores could discriminate between positive and negative outcomes for established tests for diabetic neuropathy, including cardiovascular autonomic neuropathy (CAN) and a novel method of examining the gastrointestinal visceral sensitivity. Method. We included 21 participants with longstanding type 2 diabetes, 15 with early type 2 diabetes, and 30 matched controls. The mean age for all groups was 69 years. Participants were phenotyped by cardiovascular autonomic reflex tests, electrical skin conductance, sural nerve electrophysiology, and the monofilament test. As a proxy for gastrointestinal visceral and autonomic nerve function, evoked potentials were measured following rapid rectal balloon distention. Results. Participants with longstanding diabetes scored a median (IQR) of 14.9 (10.8-28.7) points, early diabetes of 7.3 (1.6-15.2), and matched controls of 8.6 (4.1-21.6), p = 0.04 . Women and men scored 14.4 (5.5-28.7) and 7.8 (3.6-14.6) points, respectively, p = 0.01 . Participants with definite or borderline CAN scored 14.3 (10.4-31.9) points, compared to participants with no CAN, 8.3 (3.2-21.5), p = 0.04 . Lowering the diagnostic cut-off from 16 to 10 points increased the sensitivity from 0.33 to 0.83, with a decreased specificity from 0.68 to 0.55. Conclusion. We successfully used COMPASS 31 in Norwegian. Thus, following the guidelines, we suggest clinical implementation for the assessment of autonomic neuropathy. Participants with longstanding diabetes had an increased likelihood of symptoms and signs of autonomic neuropathy. For screening purposes, the sensitivity was improved by lowering the cut-off to 10 points, with a lower score nearly excluding the diagnosis.

show abstract

The PanGut-study: Evoked potentials following rectal balloon distention, a way of evaluating diabetic autonomic neuropathy in the gut?

Cited by 2 publications

References 27 publications

Rectal sensitivity correlated with gastrointestinal‐mediated glucose disposal, but not the incretin effect

Rectal sensitivity correlated with gastrointestinal‐mediated glucose disposal, but not the incretin effect

The Composite Autonomic Symptom Score 31 Questionnaire: A Sensitive Test to Detect Risk for Autonomic Neuropathy

Contact Info

Product

Resources

About