Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients

The authors investigated the effect of a balanced meal on gastric emptying rate and gastrin plasma concentrations in patients with type II diabetes an d autonomic neuropathy, in diabetic patients without autonomic neuropathy, and in healthy subjects (controls). Before food the gastrin plasma concentr ations were higher in patients with diabetes with autonomic neuropathy. Aft er food, gastric emptying rate was slower in patients with diabetes with au tonomic neuropathy, whereas gastrin plasma concentrations increased in 30 m inutes in all groups but to a greater extent in patients with diabetes with autonomic neuropathy. Sixty minutes after food, there was a significant de crease in gastrin plasma concentrations in patients with diabetes with auto nomic neuropathy, compared with the other two groups. These data suggest th at in patients with type II diabetes with autonomic neuropathy, food causes slower gastric emptying and different plasma gastrin level responses from those in patients with type II diabetes without autonomic neuropathy and co ntrols. There are therefore differences in the responses to food ingestion between these groups because of vagal denervation induced by autonomic neur opathy. These tests should be reserved for patients with symptoms suggestiv e of disturbed gastric emptying, or for patients with autonomic neuropathy without symptoms of gastroparesis.