Differences in Gastrointestinal Motility in Adults with Type 1 and Type 2 Diabetes Using Wireless Motility Capsule.

Abstract

Purpose: Gastrointestinal motility disorders are common in diabetes, though their prevalence and distribution have not been evaluated. The Wireless Motility Capsule (WMC) assesses transit times and pressures of the entire gastrointestinal (GI) tract in a single study. This study aimed to evaluate the prevalence and patterns of GI transit abnormalities using WMC in patients with diabetes.

Methods: This retrospective study included adult patients with Type 1 (T1D) and Type 2 Diabetes (T2D) who underwent WMC testing. Whole gut transit time (WGTT), gastric emptying time (GET), small bowel transit time (SBTT) and colon transit time (CTT) were analyzed. Univariate and multivariable analyses identified risk factors for delayed transit. The rates of diabetic complications were assessed. Kaplan-Meier estimates of mortality rates at 1, 3, and 5 years were compared for patients with T1D and T2D.

Results: A total of 475 patients (mean age of 54.4 years, 74% female) were included. Of these, 25.9% had T1D and 74.1% had T2D. Mean diabetes duration was 11.4 years. Patients with T1D had a higher mean disease duration of 21.7 years and those with T2D of 7.7 years. More than 35% of patients had HbA1c > 8 and 34% of patients had an HgbA1c between 6.5 and 7.99%. T1D patients had a higher mean HbA1c of 8.6% compared to 7.5% in T2D. Mean BMI was 32.3 in T2D and 26.5 in T1D. Mean BMI was higher in those with normal motility (32.9) than delayed motility (30.1). Delayed transit was observed in 75.8% with delayed GET (58.8%) being the most common abnormality. T2D had shorter median GET (4.4) than T1D (6.1) and longer CTT (95.9) than T1D (79.3). SBTT had an inverse correlation with HbA1c (-0.16). Microvascular complications were greater in T1D including neuropathy in 64.2%, retinopathy in 35% and nephropathy in 31.7% compared to T2D which were: neuropathy 50.3%, retinopathy 11.1% and nephropathy 19%. 7.3 and 1.1% of patients with T1D and T2D had kidney or pancreas transplants respectively. Kaplan-Meier analysis showed no significant difference in mortality in T1D vs T2D.

Conclusion: This study reports the prevalence of GI motility abnormalities in patients with longer duration of diabetes, higher HbA1c, lower BMI and associated diabetes microvascular complications. Delayed gastric emptying was the most common finding with greater prevalence of GET delay in T1D vs. T2D. T2D had shorter GET but longer CTT. Mean diabetes duration was 11.4 years and > 70% of patients with diabetes had suboptimal glucose control. Microvascular complications and pancreas/kidney transplant were higher in patients with T1D. Mortality rates were not different in T1D vs T2D. Identifying GI motility disorders in diabetes can guide management to improve outcomes.