CHRONIC ADMINISTRATION OF LEVOSULPIRIDE AND GLYCEMIC CONTROL IN IDDM PATIENTS WITH GASTROPARESIS

OBJECTIVE - We evaluated the effect of chronic administration of levos ulpiride, a prokinetic drug that is a selective antagonist for D-2 dop amine receptors, on the glycemic control of IDDM subjects. RESEARCH DE SIGN AND METHODS - The study was performed on 40 long-standing IDDM su bjects with clinical signs of autonomic neuropathy and delayed gastric emptying. Gastric emptying time and glycemic parameters (diurnal glyc emic profile and HbA(1c)) were checked under double-blind conditions b efore and after the administration of levosulpiride at the dosage of 2 5 mg t.i.d. orally for 6 months, or placebo. RESULTS - No significant differences were noted in the glycemic and HbA(1c) values before and a fter 6 months of placebo administration. In contrast, after 6 months o f levosulpiride, glycemic control had improved (HbA(1c) 6.7 +/- 0.4 an d 5.7 +/- 0.3%, P < 0.01; mean daily glycemia 10.9 +/- 0.8 and 8.8 +/- 0.4 mmol/l, P < 0.05, at the start and at the end of the study), whil e the dosage of injected insulin (0.65 +/- 0.02 IU . kg(-1). day(-1)) and the number of severe hypoglycemic episodes remained unchanged. Aft er 6 months of levosulpiride therapy, the time of gastric emptying was significantly reduced from 321 +/- 14 to 261 +/- 9 min (P < 0.001) an d dyspeptic symptoms had improved. CONCLUSIONS - Our results show the importance of gastric emptying in the maintenance of glycemic control and the usefulness of chronic administration of levosulpiride in diabe tic subjects with gastroparesis.