A Review of Diabetic Gastroparesis for the Community Pharmacist

Michelle E. Leatherwood, PharmD Candidate; Rachel R. Miller, PharmD Candidate; Jeffrey A. Kyle, PharmD, BCPS

Disclosures

US Pharmacist. 2016;41(12):20-23. 

In This Article

Abstract and Introduction

Abstract

Over 29.1 million people in United States have diabetes and are faced with the complications associated with the disease. Diabetes is the most common systemic disease that causes gastroparesis. Diabetic gastroparesis is commonly suspected in poorly controlled diabetic patients who present with gastrointestinal complaints, especially following a meal. Once a diagnosis is made, management of the condition is centered on optimizing blood glucose control, providing nutritional support including hydration, and in many cases using prokinetic and antiemetic medications. As healthcare providers, community pharmacists are in key positions to assist patients in how to manage this irreversible complication of diabetes.

Introduction

Approximately 9.3% of the U.S. population has diabetes.[1] This equates to about 29.1 million people who could be visiting community pharmacies for diabetes medications and supplies.[2] Diabetic patients may also seek pharmacists for education and advice on how best to maintain blood glucose control in hopes of avoiding complications such as cardiovascular disease, stroke, nephropathy, and retinopathy. Among the many complications, diabetes is the most common systemic disease that causes gastroparesis.[3]

Diabetic gastroparesis is an autonomic neuropathic complication of diabetes not due to a mechanical gastrointestinal (GI) obstruction.[4] Uncontrolled elevations of blood glucose over a long period of time can damage nerves in the enteric nervous system, which governs the GI system.[5,6] Subsequently, the stomach and small intestine as well as the smooth muscle cells of the gut are unable to function properly. When enough cells are affected, impaired peristalsis or even gastric stasis can occur.[7,8] Ultimately, this can lead to malnutrition, poor quality of life, and hospitalizations. In fact, according to Medicare-based data, the number of gastroparesis hospitalizations in the United States is on the rise.[9]

Epidemiologic studies vary widely, suggesting that diabetic gastroparesis may occur in anywhere from 1% up to 65% of patients with diabetes.[10–14] Nevertheless, it is known to be most prevalent in type 1 diabetes mellitus patients age >40 years with a 10-year history of diabetes.[14] Furthermore, gastroparesis has been shown to be more prevalent among women.[15] This article will review typical clinical characteristics along with potential management therapies of diabetic gastroparesis.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....