Diabetic gastroparesis

Objective: to provide an overview of the prevalence, clinical features, mechanisms and diagnosis of gastrointestinal motility disorders in diabetic gastroparesis (DGP), including a comparison with idiopathic gastroparesis (IGP), and current approaches to DGP treatment. The search was conducted in the RSCI, CyberLeninka, PubMed/MEDLINE, and Google Scholar databases for the period 1990–2026 using the keywords listed below. GP as a clinical syndrome is characterized by nausea, vomiting, postprandial fullness, pain, and bloating accompanied by delayed gastric emptying (GE) in the absence of mechanical obstruction. The prevalence of “definite” GP (delayed GE on scintigraphy + GP symptoms lasting >3 months) in the United States is 24.2 per 100,000 person-years, and the proportion of DGP among cases of GP of various etiologies reaches 29.0–57.4%. In DGP, nausea and vomiting are more pronounced on the PAGI-SYM scale, and SF-36 quality-of-life scores are worse than in IGP. In patients with GP and T1DM, compared with those with GP and T2DM, bloating was less frequent (p=0.04), the number of hospitalizations was higher (5.1±6.4 vs 2.7±5.7; p<0.001), severe delayed GE (>35% after 4 hours) was more frequent (53.9% vs 32.2%; p<0.001), and DGP symptoms appeared earlier (34±10 vs 49±11 years; p<0.001). Autonomic neuropathy with loss of enteric neurons is generally recognized as contributing to the multifactorial pathogenesis of DGP; other factors include loss of interstitial cells of Cajal, reduced vagal function and nNOS expression, hyperglycemia, oxidative stress, and others. Four-hour gastric-emptying scintigraphy or a ¹³C breath test is optimal for diagnosing delayed GE in DGP. International consensus recommendations for DGP treatment include nutritional support, glycemic control, rehydration, antiemetics, and prokinetics; in severe cases, enteral or parenteral nutrition and surgery may be required.

Conclusion: DGP requires a multidisciplinary approach, including earlier recognition of delayed GE and prompt comprehensive measures. This will enable more successful treatment and may help prevent the development of DGP.

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