Endocrine Abstracts

Introduction: Gastroparesis is one of the dysautonomic manifestations of diabetic disease, particularly type 1. Often unnoticed or undetected by the clinician, it can be at the heart of a permanent imbalance, giving rise to all the microvascular and macrovascular complications of dysglycemia. We report the case of a diabetic patient who, after diagnosis and treatment of gastroparesis, achieved spectacular glycemic control.

Observation: This is a 20-year-old patient with known type 1 diabetes since the age of 4, treated with insulin analogues in the basal bolus regimen; multicomplicated in all respects with diabetic renal disease classified as stage 3, diabetic neuropathy under treatment and having already undergone amputation of the right foot. The patient was a poorly controlled diabetic with multiple hospitalizations for episodes of decompensation and hypoglycemia. During her hospitalization, the diagnosis of gastroparesis was suspected in view of her postprandial hypoglycemia, nausea and sensation of early satiety, and confirmed by gastric scintigraphy. Appropriate education and treatment with metoclopramide were implemented. The evolution was marked by the appearance of an optimal glycemic balance and the disappearance of glycemic variability.

Discussion and conclusion: Gastroparesis is a disorder of the intestine-brain axis, defined as an objective slowing of gastric emptying in the absence of pyloric stenosis. It is common in diabetics, with an estimated prevalence of 1-5%, and can be responsible for a permanent imbalance with high glycemic variability. Several tests have been proposed for diagnosis, such as the carbon-13 breath test, evaluation of pyloric function or the 4-hour gastric scintigraphy, which remains the reference test; the latter allows diagnosis if the 4-hour retention time exceeds 10%. Treatment is based on dietary measures in the 1st instance, then depending on the stage of gastroparesis, anti-mimetics for a short period of 3 months, prokinetics or even gastric stimulation may be proposed in the severe stages or if the previous methods fail. It is essential to diagnose gastroparesis in diabetic patients, so that treatment can be introduced early to restore glycemic control and limit the occurrence of complications.