Reported gastroparesis in adults with type 1 diabetes (T1D) from the T1D Exchange clinic registry

Abstract

Objective: To better understand the prevalence and impact of gastroparesis in the T1D Exchange clinic registry database.

Methods: The analysis included 7107 adult participants with T1D across 45 sites (median age 46years. and median duration 24years). Linear and logistic regression models were used to assess the association of gastroparesis vs. no gastroparesis (obtained from medical record) with demographic characteristics, glycemic control and diabetes complications.

Results: Among 7107 registry participants, 340 (4.8%) had a clinical diagnosis of gastroparesis. Females were more likely to have gastroparesis compared with males (5.8% vs. 3.5%, P<0.001). Participants with gastroparesis compared with those without gastroparesis were older (median age 49.4 vs. 45.3years, P<0.001), had a longer duration of T1D (median duration 32 vs. 23years, P<0.001), higher mean HbA1c (8.1% vs. 7.7% [65 vs. 61mmol/mol], P<0.001), more frequent severe hypoglycemia (25% vs. 11% with ≥1 event in the past 12months, P<0.001), lower socio-economic status, less likely to be using CGM and insulin pump and greater prevalence of microvascular and neuropathic complications than participants without gastroparesis.

Conclusion: Gastroparesis is associated with higher risk of severe hypoglycemia despite higher HbA1c levels than in T1D patients without gastroparesis. The increased presence of multiple long-term complications and overall poor glycemic control in these subjects emphasizes the need to establish diagnostic protocols for earlier diagnosis, achieve tighter glycemic control with more extensive use of insulin pumps and continuous glucose monitoring, and the need for wider availability of medical therapies for treatment of diabetic gastroparesis.

Keywords: Adult; Complications; Diabetes management; Gastroparesis; Glycemic control; Type 1 diabetes.

Fig. 1.

Association of HbA1c and gastroparesis. Solid white bar represents gastroparesis. Black and white striped bar represents no gastroparesis. In each box, the black dot represents the mean, the horizontal line inside each box represents the median, and the bottom and top of each box represents the 25th and 75th percentiles, respectively.

Fig. 2.

Association of severe hypoglycemia (SH) and gastroparesis. Solid white bar represents gastroparesis. Black and white striped bar represents no gastroparesis.

Fig. 3.

Association between diabetes-related complications and gastroparesis in T1D. Solid white bar represents gastroparesis. Black and white striped bar represents no gastroparesis.