Reported gastroparesis in adults with type 1 diabetes (T1D) from the T1D Exchange clinic registry

Objective: To better understand the prevalence and impact of gastroparesis in the T1D Exchange clinic registry database. Methods: The analysis included 7107 adult participants with T1D across 45 sites (median age 46 years. and median duration 24 years). Linear and logistic regression models were used to assess the association of gastroparesis vs. no gastroparesis (obtained from medical record) with demographic characteristics, glycemic control and diabetes complications. Results: Among 7107 registry participants, 340 (4.8%) had a clinical diagnosis of gastroparesis. Females were more likely to have gastroparesis compared with males (5.8% vs. 3.5%, P < 0.001). Participants with gastroparesis compared with those without gastroparesis were older (median age 49.4 vs. 453 years, P < 0.001), had a longer duration of T1D (median duration 32 vs. 23 years, P < 0.001), higher mean HbA1c (8.1% vs. 7.7% [65 vs. 61 mmol/mol], P < 0.001), more frequent severe hypoglycemia (25% vs. 11% with >= 1 event in the past 12 months, P < 0.001), lower socio-economic status, less likely to be using CGM and insulin pump and greater prevalence of microvascular and neuropathic complications than participants without gastroparesis. Conclusion: Gastroparesis is associated with higher risk of severe hypoglycemia despite higher HbA1 c levels than in T1D patients without gastroparesis. The increased presence of multiple long-term complications and overall poor glycemic control in these subjects emphasizes the need to establish diagnostic protocols for earlier diagnosis, achieve tighter glycemic control with more extensive use of insulin pumps and continuous glucose monitoring, and the need for wider availability of medical therapies for treatment of diabetic gastroparesis. (C) 2017 Elsevier Inc. All rights reserved.