Risk factors and early detection of gastroparesis in patients with type 2 diabetes mellitus

Keywords: predictors; questionnaires; delayed gastric emptying; 13C-octanoic acid breath test.


Nowadays, diabetes mellitus is considered as one of the greatest global problems in internal medicine as it results in multiple organ damage and irreversible changes in the vital functional systems of the body. Unfortunately, there are no statistical data on the prevalence of gastrointestinal autonomic neuropathy in patients with type 2 diabetes mellitus in the Ukrainian population; making an early accurate diagnosis can be a clinical challenge since its manifestations are often considered as the manifestations of other diseases. Multifaceted clinical manifestations of gastroparesis cause difficulties in making a timely diagnosis, which can lead to an unfavourable prognosis. Diabetic gastroparesis symptoms were found in 45.5% of patients with type 2 diabetes mellitus: mild gastroparesis was observed in 29 (18.6%) patients; moderate gastroparesis was seen in 32 (20.5%) subjects; the signs of severe diabetic gastroparesis were present in 10 (6.4%) patients only. According to the assessment of the Neuropathy Disability Score, in patients with type 2 diabetes mellitus (disease duration of more than 10 years) and severe manifestations of polyneuropathy, the presence of risk factors for hypoglycemia as well as cigarette smoking are predictors of the development and progression of diabetic gastroparesis symptoms. They include a positive family history of diabetes mellitus, chronic microvascular complications of diabetes mellitus, concomitant cardiovascular diseases. Diabetes mellitus duration of more than 10 years, severe manifestations of polyneuropathy, increase in the incidence of hypoglycemic episodes as well as cigarette smoking should be considered as risk factors for gastroparesis in type 2 diabetes mellitus. We developed a mathematical model to assess the risk of developing gastroparesis in patients with type 2 diabetes mellitus using the results of a questionnaire (the Gastroparesis Cardinal Symptom Index, the Hypoglycemia Fear Survey-Total), and the Neuropathy Disability Score. For future research into diabetic gastroparesis, we recommend that a multicenter study is performed with an increased sample size because the early detection of delayed gastric emptying in this study was as high as we expected. Importantly, a case study of the complete disease history and questionnaires for the early diagnosis of delayed gastric emptying are required for studying the exact risk factors of autonomic neuropathy of the stomach in patients with type 2 diabetes mellitus.


Almogbel, R., Alhussan, F., Alnasser, S., & Algeffari, M. (2016). Prevalence and risk factors of gastroparesis-related symptoms among patients with type 2 diabetes. International Journal of Health Sciences, 10(3), 397–404.

AlOlaiwi, L., AlHarbi, T., & Tourkmani, A. (2018). Prevalence of cardiovascular autonomic neuropathy and gastroparesis symptoms among patients with type 2 diabetes who attend a primary health care center. PLoS One, 13(12), e0209500.

American Diabetes Association (2017). Comprehensive medical evaluation and assessment of comorbidities. Diabetes Care, 40(Suppl. 1), S25–S32.

Anudeep, V., Vinod, K. V., Pandit, N., Sharma, V., Dhanapathi, H., Dutta, T., & Sujiv, A. (2016). Prevalence and predictors of delayed gastric emptying among Indian patients with long-standing type 2 diabetes mellitus. Indian Journal of Gastroenterology, 35, 385–392.

Avalos, D., Sarosiek, I., Loganathan, P., & McCallum, R. (2018). Diabetic gastro paresis: Current challenges and future prospects. Clinical and Experimental Gastroenterology, 11, 347–363.

Babak, O., & Kolesnikova, E. (2012). Patologija verhnih otdelov zheludochno-kishechnogo trakta i saharnyj diabet: V chem skryvaetsja ugroza dlja pacienta? [Pathology of the upper gastrointestinal tract and diabetes mellitus: What is the threat to the patient?]. Ukrajins'kyj Terapevtychnyj Zhurnal, 2, 116–120 (in Russian).

Borges, C., Secaf, M., & Troncon, L. (2013). Clinical features and severity of gastric emptying delay in Brazilian patients with gastroparesis. Arquivos de Gastroenterologia, 50, 270–276.

Camilleri, M. (2016). Functional dyspepsia and gastroparesis. Digestive Diseases, 34, 491–499.

Choung, R., Locke, G., Schleck, C., Zinsmeister, A., Melton, L., & Talley, N. (2011). Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population. American Journal Gastroenterology, 107, 82–88.

Choung, R., Locke, G., Schleck, C., Zinsmeister, A., Talley, N., & Nicholas, M. (2008). Cumulative incidence of gastroparesis in people with type 1 and 2 dia betes in the general population. American Journal Gastroenterology, 103, S399.

Chuenyong, K., Pornananrat, A., Sarinnapakorn, V., & Kuanrakcharoen, P. (2018). Early detection of diabetic gastroparesis in type 2 diabetes using diabetic peri pheral neuropathy as a surrogate marker: A pilot study in Rajavithi hospital. Asian Journal of Pharmaceutics, 12(2), S.538–S.544.

Darwiche, G., Mohammed, S., Aldawi, N., Skaria, S., & Tesfa, Y. (2014). Gastro paresis among type 1 and type 2 diabetic patients in the United Arab Emirates. Journal of Diabetes Mellitus, 4(2), 96–106.

Dickman, R., Wainstein, J., Glezerman, M., Niv, Y., & Boaz, M. (2014). Gender aspects suggestive of gastroparesis in patients with diabetes mellitus: A cross-sectional survey. BMC Gastroenterology, 19, 14–34.

Edula, R., Roque, M., & Bouras, E. (2014). How reliable is a diagnosis of gastro paresis? Gastroenterology, 146(5), 617–618.

Elson, С. (2011). Epidemiology, mechanisms, and management of diabetic gastro paresis. Clinical Gastroenterology Hepatology, 9, e6–e8.

Friedenberg, F., Kowalczyk, M., & Parkman, H. (2013). The influence of race on symptom severity and quality of life in gastroparesis. Journal of Clinical Gastroenterology, 47(9), 757–761.

Halland, M., & Bharucha, A. (2016). Relationship between control of glycemia and gastric emptying disturbances in diabetes mellitus. Clinical Gastroentero logy and Hepatology, 14(7), 929–936.

Huang, Y., Zhang, H., Zhang, M., Li, W., Wang, J., & Hu, J. (2017). The Asso ciation between fasting C-peptide and gastrointestinal symptoms of gastropa resis in type 2 diabetic patients. Journal of Neurogastroenterology and Motility, 23(2), 254–261.

Intagliata, N., & Koch, K. (2007). Gastroparesis in type 2 diabetes mellitus: Preva lence, etiology, diagnosis, and treatment. Current Gastroenterology Reports, 9(4), 270–279.

Jung, H., Choung, R., Locke, G., Schleck, C., Zinsmeister, A., Szarka, L., Mullan, B., & Talley, N. (2009). The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology, 136, 1225–1233.

Kempler, P., Várkonyi, T., Körei, A., & Horváth, V. (2016). Gastrointestinal auto nomic neuropathy in diabetes: The unattended borderline between diabetology and gastroenterology. Diabetologia, 59, 401–403.

Koch, K., Hasler, W., Yates, K., Parkman, H., Pasricha, P., Calles-Escandon, J., Snape, W., Abell, T., McCallum, R., Nguyen, L., Sarosiek, I., Farrugia, G., Tonascia, J., Lee, L., Miriel, L., & Hamilton, F. (2016). Baseline features and differences in 48 week clinical outcomes in patients with gastroparesis and type 1 vs type 2 diabetes. Neurogastroenterology and Motility, 28, 1001–1015.

Kostitska, I. (2015). Vykorystannja opytuval'nykiv pacijentiv dlja rann'oji diagnostyky diabetychnogo gastroparezu [Patients using questionnaires for early diagnosis of diabetic gastroparesis]. Problemy Endokrynnoji Patologiji, 3, 32–37 (in Ukrainian).

Kostitska, I., & Mankovsky, B. (2017). Vzajemozv’jazok mіzh dіabetiyhnym gastroparezom і ryzykom rozvytku gіpoglіkemіchnyh stanіv [Relationships between diabetic gastroparesis and risk of developing hypoglycemic condi tions]. Mezhdunarodnyi Endokrinologicheskii Zhurnal, 13, 41–47 (in Ukrainian).

Krishnan, B., Babu, S., Walker, J., Walker, A., & Pappachan, J. (2013). Gastrointes tinal complications of diabetes mellitus. World Journal of Diabetes, 4(3), 51–63.

Krishnasamy, S., & Abell, T. (2018). Diabetic gastroparesis: Principles and current trends in management. Diabetes Therapy, 9(1), S1–S42.

Kumar, M., Chapman, A., Alam, U., Javed, S., Malik, R., & Azmi, S. (2018). The investigation and treatment of diabetic gastroparesis. Clinical Therapeutics, 6 40, 850–861.

Lacy, B., Crowell, M., Mathis, C., Bauer, D., & Heinberg, L. (2018). Gastropare sis: Quality of life and health care utilization. Journal of Clinical Gastroente rology, 52(1), 20–24.

Lacy, B., DiBaise, J., Pimentel, M., & Ford, A. (Eds.). (2019). Essential medical disorders of the stomach and small intestine. Springer International Publishing.

Lam, A., Xin, X., Tan, W. B., Gardner, D., & Goh, S. (2017). Psychometric validation of the hypoglycemia fear survey-II (HFS-II) in Singapore. BMJ Open Diabetes Research and Care, 5, e000329.

Lee, A., & Hasler, W. (2017). Diabetes and the stomach. Current Treatment Opti ons in Gastroenterology, 15(4), 441–459.

Li, X., Reed, N., Li, Q., Hoke, A., & Pasricha, P. (2014). Effects of pre-diabetic obesity on gastric and somatic neuropathy – morphological and functional changes linking obesity to gastroparesis. Gastroenterology, 146(5), 608–609.

Parkman, H., Hallinan, E., Hasler, W., Farrugia, G., Koch, K., Nguyen, L., Snape, W., Abell, T., McCallum, R., Sarosiek, I., Pasricha, P., Clarke, J., Miriel, L., Tonascia, J., & Hamilton, F. (2017). Early satiety and postprandial fullness in gastroparesis correlate with gastroparesis severity, gastric emptying, and water load testing. Neurogastroenterology and Motility, 29, e12981.

Pasricha, P., Camilleri, M., Hasler, W., & Parkman, H. (2017). White paper AGA: Gastroparesis: Clinical and regulatory insights for clinical trials. Clinical Gastroenterology and Hepatology, 15, 1184–1190.

Polonsky, W., Fisher, L., Hessler, D., & Edelman, S. (2017). Investigating hypoglycemic confidence in type 1 and type 2 diabetes. Diabetes Techno logy and Therapeutics, 19(2), 131–136.

Pop-Busui, R., Boulton, A., Feldman, E., Bril, V., Freeman, R., Malik, R., Sosen ko, J., & Ziegler, D. (2017). Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care, 40, 136–154.

Rakan, A., Fulwa, A., Sulaiman, A., & Metab, A. (2016). Prevalence and risk factors of gastroparesis-related symptoms among patients with type 2 diabetes. International Journal of Health Sciences, 10(3), 398–404.

Reddy, S., Ramsubeik, K. P., Federico, J. R., Goodwich, R. B., Palacio, C., & Vega, K. (2009). Do HbA1C levels correlate with delayed gastric emptying in diabetic patients? Gastroenterology, 136(5), 784.

Revicki, D., Camilleri, M., Kuo, B., Szarka, L., McCormack, J., & Parkman, H. (2012). Evaluating symptom outcomes in gastroparesis clinical trials: Validity and responsiveness of the gastroparesis cardinal symptom index-daily diary (GCSI-DD). Journal of Neurogastroenterology and Motility, 24(5), 456–463.

Revicki, D., Lavoie, S., Speck, R., Puelles, J., Kuo, B., Camilleri, M., Almansa, C., & Parkman, H. (2018). The content validity of the ANMS GCSI - DD in patients with idiopathic or diabetic gastroparesis. Journal of Patient-Reported Outcomes, 61(2), 1–10.

Rodrigues, M., & Motta, M. (2012). Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus. Jornal de Pediatria, 88(1), 17–24.

Sayyar, M., Edwin, L., Patel, J., Nath, A., Tefera, E., & Cho, W. (2016). The over looked factors that may lead to delayed gastric emptying. Gastroenterology, 150(4), 728–729.

Syed, A., Calles-Escandon, J., Wolfe, M. (2015). Epidemiology of gastroparesis with and without diabetes mellitus in a large cohort from 340 US hospitals. Gastroenterology, 148(4), 505–506.

Tayupova, D., Valeeva, F., Safiullina, L., & Bareeva, L. (2015). Functional diag nostics of gastrointestinal autonomic neuropathy. Innovative Technologies in Medicine, 89(4), 136–138.

Tkach, S. (2017). Diabeticheskij gastroparez: Jepidemiologija, mehanizmy razvitija, sovremennye podhody k vedeniju bol'nyh [Diabetic gastroparesis: Epidemio logy, mechanisms of development modern approaches to the management]. Klіnіchna Endokrinologіja ta Endokrinna Hіrurgіja, 58(2), 9–18 (in Russian).

Tronko, M., Sokolova, L., Vlasenko, N., & Kostukevich, A. (2015). Dostizhenie celej lechenija pacientami s saharnym diabetom v Ukraine. Rezul'taty Mezh dunarodnogo issledovanija po izucheniju praktiki vedenija saharnogo diabeta (IDMPS) [Achieving the goals in treatment of patients with diabetes mellitus in Ukraine. Results of the International Diabetes Management Practices Study (IDMPS)]. Endokrynologija, 20(4), 658–668 (in Russian).

Valeriani, M., Brock, C., Graversen, C., Frøkjaer, J., Søfteland, E., & Drewes, A. (2013). Peripheral and central nervous contribution to gastrointestinal symp toms in diabetic patients with autonomic neuropathy. Clinical Neurophysio logy, 124(11), e193.

Woodhouse, S., Hebbard, G., & Knowles, S. (2017). Psychological controversies in gastroparesis: A systematic review. World Journal of Gastroenterology, 23(7), 1298–1309.

Yu, D., Ramsey, F., Norton, W., Norton, N., Schneck, S., Gaetano, T., & Park man, H. (2017). The burdens, concerns, and quality of life of patients with gastroparesis. Digestive Diseases and Sciences, 62(4), 879–893.

Yun, H., Honghong, Z., Minxia, Z., Wenya, L., Jinhua, W., & Ji, H. (2017). The association between fasting C – peptide and gastrointestinal symptoms of gastroparesis in type 2 diabetic patients. Journal of Neurogastroenterology and Motility, 23(2), 254–261.

Zhao, L., Ma, J., Wang, S., & Xie, Y. (2015). Relationship between β-cell func tion, metabolic control, and microvascular complications in type 2 diabetes mellitus. Diabetes Technology and Therapeutics, 17, 29–34.

Zviahintseva, T., & Chernobai, A. (2015). Funkcіonal'nі zahvoriuvannia organіv travlennia ta jih pojednannia u svіtlі suchasnyh ujavlen': Vіd patogenezu do lіkuvannia [Functional gastrointestinal diseases and their combinations in view of the modern concepts: From pathogenesis to treatment]. Suchasna Gastroenterologіja, 83(3), 61–72 (in Ukainian).

How to Cite
Kostitska, I. O., Mankovsky, B. M., UrbanovychА. М., Zhurakivska, O. Y., Tymoshchuk, O. V., & Basiuha, I. O. (2019). Risk factors and early detection of gastroparesis in patients with type 2 diabetes mellitus . Regulatory Mechanisms in Biosystems, 10(1), 56-62. https://doi.org/10.15421/021909