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Cited by 199Gastrointestinal motility and disordersDiabetes Management and ResearchDiabetes Treatment and Management

Diabetic Gastroparesis: Principles and Current Trends in Management

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Krishnasamy, Sathya, Abell, Thomas L.·2018·Diabetes Therapy
DOI 10.1007/s13300-018-0454-9PMC PMC6028327
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Abstract

This article is a comprehensive review of diabetic gastroparesis, defined as delayed or disordered gastric emptying, including basic principles and current trends in management. This review includes sections on anatomy and physiology, diagnosis and differential diagnosis as well as management and current guidelines for treatment of diabetic gastroparesis. Diabetic gastroparesis (DGp) is a component of autonomic neuropathy resulting from long-standing poorly controlled type 1 and type 2 diabetes. The diagnostic workup of DGp first excludes obstruction and other causes including medications that may mimic delayed/disordered gastric emptying. Targeting nutrition, hydration, symptomatic relief and glycemic control are mainstays of treatment for DGp. Additionally, optimal treatment of DGp includes good glycemic management, often involving customizing insulin delivery using basal-bolus insulin and technology, including sensor-augmented pumps and continuous glucose monitoring systems. Prokinetic medications may be helpful in DGp symptoms, although only limited number of medications is currently available in the USA. Selected medication-refractory patients with DGp may benefit from gastric neuromodulation, and some from surgical interventions including pyloric therapies that can also be done endoscopically. As is true of any of the diabetic complications, prevention of DGp by early and optimal glycemic control is more cost-effective.Funding: Hansa Medcell, India.

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  • In diabetes, insulin and IGF-1 deficiency causes muscle atrophy and reduced SCF production, leading to ICC depletion and impaired neuromuscular transmission.

    “In diabetes, insulin and IGF-1 deficiency causes muscle atrophy and reduced SCF production, leading to ICC depletion and impaired neuromuscular transmission [52–60].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [54]

    The Pathogenesis section says insulin and IGF-1 promote smooth-muscle production of stem cell factor, an ICC survival factor, and that their deficiency is detrimental to ICC. It also describes ICC involvement in neurotransmission. However, Table 3 lists smooth-muscle atrophy with decreased IGF-1 and ICC loss; it does not establish the claimed direction that insulin and IGF-1 deficiency causes muscle atrophy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Chronic and acute hyperglycemia inhibit gastric motility by reducing vagal cholinergic activity, impairing fundic relaxation, slowing antral peristalsis, and diminishing pyloric compliance, creating a self-perpetuating cycle between worsening metabolic control and gastrointestinal symptoms.

    “Furthermore, chronic and acute hyperglycemia inhibit gastric motility by reducing vagal cholinergic activity, impairing fundic relaxation, slowing antral peristalsis, and diminishing pyloric compliance, creating a self-perpetuating cycle between worsening metabolic control and gastrointestinal symptoms [6, 23, 92, 103, 104].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [103]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • "Cajalopathy" is considered the most common alteration found in both diabetic and idiopathic gastroparesis.

    “This condition, often referred to as “cajalopathy”, is considered the most common alteration found in both diabetic and idiopathic gastroparesis [54].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [54]

  • The reduction in ICCs interrupts functional communication between enteric neurons and smooth muscle, generating irregular slow waves and variable responses to interventions such as gastric electrical stimulation.

    “The reduction in ICCs interrupts functional communication between enteric neurons and smooth muscle, generating irregular slow waves and variable responses to interventions such as gastric electrical stimulation [54].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [54]

  • Sensor‐augmented pump systems (SAP) enable adaptive insulin delivery, including dual‐wave or square‐wave boluses, which distribute insulin over several hours and better match the slow and prolonged glucose absorption typical of DGP, particularly in high‐fat or high‐protein meals.

    “Sensor‑augmented pump systems (SAP) enable adaptive insulin delivery, including dual‑wave or square‑wave boluses, which distribute insulin over several hours and better match the slow and prolonged glucose absorption typical of DGP [54, 112, 132, 148, 149], particularly in high‑fat or high‑protein meals [150–152].”

    From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [54]

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Authors
Krishnasamy, S., & Abell, T. L.
Affiliations
University of Louisville (US)
Corresponding author
Abell, Thomas L.
ORCID
Venue
Diabetes Therapy
Publisher
Springer Science and Business Media LLC
Published
2018-06-22
Volume
9
Issue
S1
Pages
1-42
ISSN
  • 1869-6953 (ISSN-L)
  • 1869-6961
DOI
10.1007/s13300-018-0454-9
PMC
PMC6028327
OpenAlex
W2808844694
Cited by
199
References
16
Citations by year
2026: 14 · 2025: 16 · 2024: 29 · 2023: 30 · 2022: 32 · 2021: 38 · 2020: 25 · 2019: 11 · 2018: 3 · 2017: 1
FWCI
3.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Therapy (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
University of Louisville
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
diabetic gastroparesis, delayed gastric emptying, autonomic neuropathy, type 1 diabetes, type 2 diabetes, glycemic control, multiple daily insulin injections, continuous glucose monitoring, sensor-augmented pump, prokinetic agents, nutrition and hydration

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