Continuous glucose monitoring in gastroparesis

Background: Delayed gastric emptying can alter glucose levels in diabetic patients; hyperglycemia can delay gastric emptying. Continuous glucose monitoring (CGM) may be useful to assess the relationship between gastric emptying and blood glucose levels. Aims: The aims of this study were to compare the postprandial blood glucose profile of patients with type 2 diabetes mellitus (T2DM) with and without gastroparesis, normal subjects, and patients with idiopathic gastroparesis (IG), and also to determine the effect of different meal compositions on glucose regulation in T2DM and normals. Methods: Seven patients with IG, seven T2DM with gastroparesis, ten non-gastroparetic T2DM, and ten normal subjects underwent CGM during a low fat (Eggbeaters) meal. Glucose profiles were also studied in T2DM and normal subjects after high fat, high fiber, spicy, and Ensure liquid nutrient meals. Results: After the Eggbeaters meal, the glucose profile of IGs and normals were similar. Diabetic patients with gastroparesis had similar peak postprandial blood glucose to nongastroparetic diabetics (231 ± 26 vs. 232 ± 18 mg/dl), but had a higher postprandial blood glucose at the end of the 4 h study (187 ± 26 mg/dl vs. 97 ± 10; P = 0.01). In contrast to normals, non-gastroparetic diabetics had higher mean postprandial blood sugar after the Eggbeaters meal (173 ± 5 mg/dl) compared to high fat (157 ± 3; P = 0.002), spicy (133 ± 2; P < 0.001) and Ensure meals (152 ± 1; P < 0.001). Conclusions: Blood glucose monitoring provides insight to the presence of gastroparesis in diabetic patients: diabetic gastroparetics had prolonged postprandial hyperglycemic profile as compared to non-gastroparetic diabetics. Of the meals tested, the low fat (Eggbeaters) meal was associated with the highest mean postprandial glucose in diabetics.