Prevalence and Patterns of Dysmotility in Patients with Diabetes

Introduction: Gastrointestinal (GI) symptoms are common in patients with diabetes mellitus (DM) and are often associated with underlying dysmotility, which may be related to autonomic neuropathy. Wireless Motility Capsule (WMC) allows assessment of transit times of the entire GI tract in a single study. The prevalence of dysmotility and its distribution in patients with DM have not been well described. We aimed to investigate the prevalence and patterns of GI dysmotility and identify associated factors using WMC testing in patients with DM. Methods: A retrospective observational cohort study was done on patients with Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) undergoing WMC testing. The primary aim of the study was presence of dysmotility defined as delayed WGTT (whole gut transit time), gastric emptying time (GET), SBTT (small bowel transit time), CTT (colon transit time) as seen on WMC testing in patients with DM. Univariate and multivariate analyses were conducted to assess for risk factors associated with dysmotility in diabetic patients. Results: Four hundred and eighty-two patients were included with a mean age of 54.2 ± 13.9 years. 74.1% were female and 73.9% were White. 20.2% (n=88) had T1D and 79.8% (n=348) had T2D with a median disease duration of 1.8 [0.32, 6.1] years. Overall, 75.7% (n= 365) of the patients had dysmotility; delayed GET (58.8%) being the most common followed by WGTT (38.5%), CTT (34.3%) and SBTT (23.1%). In all multivariable models, increasing BMI was associated with lower rates of dysmotility (OR 0.96 [0.93, 0.99]; P-value < 0.002). This was further demonstrated in individual measures of motility (Table 1). In addition, in the multivariable models, increasing age, female gender, and diabetes duration of 1-4.99 years (relative to less than 1 year) were associated with increased CTT delay (Table 1), while diabetes duration of 1-4.99 years and 5-9.99 years (both relative to less than 1 year) were associated with greater risk of SBTT delay (Table 1). Conclusion: We conclude that gastric dysmotility is the most prevalent with a high rate of WGTT, CTT, and SBTT delay. Furthermore, we demonstrated that increasing BMI was associated with lower rates of dysmotility. These findings support the need for and utility of WMC testing to evaluate global dysmotility in diabetic patients. Large prospective studies are needed to assess the prevalence and patterns of GI dysmotility to guide proper management strategies for patients with diabetes. Table 1. - Multivariate analysis of smartpill dysmotility measures by patient characteristics WGTT Delay GET Delay CTT Delay SBTT Delay Characteristics N OR (95% CI)1 P-value N OR (95% CI)1 P-value N OR (95% CI)1 P-value N OR (95% CI)1 P-value Age 475 1.01 (1.00, 1.03) 0.15 478 0.99 (0.98, 1.01) 0.42 464 1.03 (1.01, 1.04) 0.001 472 0.99 (0.97, 1.01) 0.27 BMI 469 0.97 (0.94, 0.99) 0.012 471 0.97 (0.94, 0.99) 0.008 458 0.97 (0.94, 1.00) 0.022 465 0.96 (0.93, 0.99) 0.015 Race White 345 — — 348 — — 337 — — 342 — — Black 84 1.11 (0.67, 1.84) 0.67 84 1.06 (0.65, 1.75) 0.81 82 1.06 (0.63, 1.80) 0.81 84 1.46 (0.85, 2.51) 0.17 Other 24 0.85 (0.35, 2.05) 0.71 25 1.12 (0.47, 2.64) 0.8 23 0.89 (0.36, 2.22) 0.81 24 0.48 (0.13, 1.83) 0.28 Gender Female 351 — — 353 — — 343 — — 351 — — Male 124 0.69 (0.44, 1.08) 0.11 125 1.06 (0.68, 1.64) 0.8 121 0.53 (0.32, 0.86) 0.011 121 1.16 (0.71, 1.92) 0.55 Diabetes Type I 86 — — 87 — — 81 — — 85 — — II 343 0.74 (0.45, 1.22) 0.24 345 0.69 (0.41, 1.17) 0.17 337 1.08 (0.63, 1.86) 0.78 341 1.21 (0.66, 2.22) 0.54 DM Duration Less than 1 year 170 — — 173 — — 168 — — 172 — — 1-4.99 years 130 1.50 (0.94, 2.37) 0.088 132 1.16 (0.72, 1.84) 0.54 126 1.64 (1.01, 2.64) 0.044 128 2.34 (1.35, 4.05) 0.003 5-9.99 years 89 0.75 (0.42, 1.31) 0.31 89 1.51 (0.85, 2.68) 0.15 87 0.83 (0.46, 1.48) 0.52 89 1.96 (1.04, 3.71) 0.038 10+ years 40 0.67 (0.32, 1.41) 0.29 38 0.89 (0.44, 1.83) 0.76 37 0.51 (0.22, 1.19) 0.12 37 1.37 (0.54, 3.49) 0.51 HbA1c Group < 6.5 191 — — 192 — — 185 — — 191 — — 6.5-7.99 142 1.10 (0.68, 1.77) 0.7 143 0.79 (0.49, 1.25) 0.31 139 0.90 (0.54, 1.50) 0.7 141 1.14 (0.66, 1.95) 0.64 8-9.99 years 90 1.05 (0.60, 1.84) 0.85 91 1.68 (0.95, 2.98) 0.077 88 1.13 (0.63, 2.03) 0.67 88 0.78 (0.41, 1.48) 0.44 10+ 52 1.05 (0.54, 2.04) 0.89 52 0.74 (0.39, 1.41) 0.36 52 1.15 (0.57, 2.29) 0.7 52 0.50 (0.21, 1.19) 0.12