Glucose Control is Not Improved by Accelerating Gastric Emptying in Patients with Type 1 Diabetes Mellitus and Gastroparesis. A Pilot Study with Cisapride as a Model Drug.

摘要

The present pilot study investigated whether acceleration of gastric emptying in patients with type 1 diabetes and delayed gastric emptying (a possible cause of poorly controlled diabetes) improves long-term glucose control. Eight outpatients with diabetes (age 28 - 63 years, mean diabetes duration 24.6 +/- 6.0 years) and delayed gastric emptying of radio-opaque markers were randomised and treated, for three months each, with a prokinetic drug (cisapride 20 mg twice daily) and placebo. Mean capillary glucose, glucose variability (M-values, MAGE), fructosamine, and HbA1c were assessed. Gastric emptying of a solid standard meal was measured by scintigraphy after each treatment period. Chronic administration of a prokinetic drug resulted in improved solid gastric emptying (percentage residual) at 120 min (p = 0.025). The percentage residual was 43.6 +/- 9.6 % during prokinetic treatment and 59.7 +/- 9.9 % during placebo (standard error of paired differences 5.7 %). The mean gastric emptying time (t/2) of solids was 88 min during prokinetic treatment compared to 113 min in the placebo arm (SE of paired differences 14 min; p = 0.09). Mean blood glucose values (9.0 +/- 3.8 vs. 8.8 +/- 3.7 mmol/l), daily glucose variability (MAGE 6.8 +/- 1.3 vs. 6.3 +/- 1.6 mmol/l; M-value 15.2 +/- 2.5 vs. 13.9 +/- 4.5), and HbA1c at 3 months (7.8 +/- 1.1 % vs. 7.6 +/- 1.0 %) were not statistically different between prokinetic drug and placebo treatment. Similarly, the frequency of hypoglycaemic episodes (