| Background and objectiveDiabetes has become a chronic disease that seriously threat to human’s health and life all over the world. Statistics from international diabetes federation indicated that there were no less than 370 million patients worldwide in 2011, and the patients from the developing countries accounted for 80%. The number of patients is projected to grow to 550 million by the year 2030. Nowadays, there are more than 100 million diabetes in China, further more the incidence advanced rapidly in the recent years. Diabetes mellitus is a kind of metabolic disease, which not only damage the psychosomatic healthy, significantly decline the quality of life and shorten the life expectancy, but also extremely increase the burden of health care and social responsibility. As the diabetes progressing, it can induce a series of life-threaten complications inevitably.Gastrointestinal motility dysfunction was an extremely common complication of diabetic mellitus. It is difficult to diagnose exactly because of its atypical symptoms, the disturbance of some other gastrointestinal disorders and fewer specific diagnose measures currently. Long-term gastrointestinal disorders not only increase the psychosomatic burden, remarkably affect food digestion and nutrition absorption, decrease the drug efficiency, but also lead to acute or chronic metabolic disorders seriously. As the disease progressing, some complications such as, diabetic gastroparesis and severe intestinal-colon lower motility will occur inevitably. The therapeutic strategies are limited and the outcome is always unsatisfactory. Therefore, we should pay more attention to the early detection and timely treatment to diabetic gastrointestinal dysfunctions. Only in this way can we slow down or avoid the disease progressing. Several methods, such as endoscope, ultraphonic, barium meal and radionuclide imaging, can be used in evaluating gastrointestinal motor function. Compared with other methods, the scintigraphy imaging had been identified as the “Golden standard” owe to much more advantages in image definition, repeatability and physiological characters. Applying the radionuclide imaging, the purpose of this study is to investigate the gastrointestinal motility function before the gastrointestinal dysfunction symptoms appeared and to explore the relative metabolic risk factors in the patients with type 2 diabetes mellitus(T2DM). It also provides directions on the early detections of gastrointestinal disorders and the effective intervention measures.Traditionally, the main therapeutic opinions of diabetes involve long-term glucose-lowering oral medications and insulin injection. Roux-en-Y gastric bypass surgery which is mainly applied in bariatric surgery provides an opportunity to throw away oral anti-diabetic drugs and obtain clinically cure for the patients. While, investigations on gastrointestinal motility following the gastric bypass surgery mainly focused on gastrointestinal hormon detection, fewer researches about imageological examination have been studied. This study also aims to test the changes of metabolism and gastrointestinal motility after gastric bypass surgery with radionuclide imaging.Research subjects21 T2 DM subjects(6 obese subjects applying Roux-en-Y gastric bypass surgery termed surgery group and 15 T2 DM non-obese subjects termed diabetes group, with mean age 43 ± 8 and 49 ± 10 years respectively) and 18 health volunteers named healthy group, with mean age 52 ± 13 years, were enrolled from the Department of Hypertension & Endocrinology, Institute of Hypertension Research, Daping hospital, Third Military Medical University between June 2012 and February 2014. This study was approved by the hospital ethical committee and written informed constants were obtained from all the participants. All the subjects yet took drugs recently which could influence the motility of the gastrointestinal and those who had other types of diabetic mellitus, advanced age, pancreas islets extremely dysfunction, acute-complications, gastrointestinal disorder symptoms, some other severe diseases and verified surgery contraindications were been excluded.MethodsGeneral information including age, medical history, height, weight, blood pressure, liver and kidney function, lipid level, blood glucose, insulin, glycosylated hemoglobin A1c(Hb A1c) and some other critical clinic biochemical factors were measured. The electrocardiogram and chest radiography were applied in all subjects. The limb nerve evoked potentials and diabetes auto-antibodies were tested in the patients. Those who received gastric bypass surgery must conducted endoscope examination before the surgery. Radiography images were collected following the administration of 2m Ci 99 m Tc labeling polenta test-meals, and then the gastric emptying and intestinal movement time were calculated. With the same methods, images were once more applied within 6 to 8 months after the gastric bypass surgery. Comparison in general indexes and gastrointestinal movement time were applied between the two groups, and the risk factors of gastrointestinal motility had been estimated. Basic information, biochemical indexes and the liner correlation analysis were studied in the surgery group.Statistics analysis was performed utilizing the Graph Pad Prism 5.1(La Jolla, CA, USA) and SPSS18.0 software. Measurement data were presented as mean ± SD. Comparison of parameters between groups were made with Student’s t test. The risk factors of gastrointestinal motility were estimated using multiple stepwise regression analysis, and Pearson chi-square tests were applied to compare the gender difference between groups. P value < 0.05 was regarded as a significant effect or between-group difference.Results1、All the subject have no gastrointestinal disorder symptoms, such as lack of appetite, nausea, emesis, early satiety, diarrhea, abdominal pain, astriction and so on;2、When compared with health volunteers, parameters such as fasting plasma glucose(FPG), oral glucose tolerances test 2h plasma glucose(OCTT 2h PG), Hb A1 c, Homa-insulin resistance index(HOMA-IR), triglyceride(TC), total cholesterol(TG) and weight in T2 DM patients were significantly increased; there were no difference in systolic blood pressure(SBP), diastolic blood pressure(DBP), age, height and body mass index(BMI) between those two groups indicating a great consistence;3、The gastric emptying time of diabetes group(133.3 ± 22.3 min) were remarkably prolonged comparing with control group(114.3 ± 17.9 min), P<0.05. Both OGTT 2h PG and TG were the risk factors of the extension gastric emptying time, P<0.05;4、Similarly, The intestinal movement time of diabetes(87.90 ± 13.76 min) were notably extended comparing with control subjects(67.4 ± 13.6 min), P<0.01. The study also indicated that OGTT 2h PG, TC and TG were the risk factors of the augment intestinal movement time, P<0.05;5、When compared with pre-operation subjects, parameters such as weight, BMI, fat mass rate, FPG, OGTT 2h PG, Hb A1 c, HOMA-IR and TG in post-operation patients were significantly decreased; the high density lipoprotein cholesterol(HDL-C) of post-operation subjects were remarkably increased; there were no differences in TC between those two groups, but had an decreased tendency;6、After the gastric bypass surgery, the gastric emptying time of patients were significantly decreased(74.2 ± 19.7 min vs 127.5 ± 18.1 min, p<0.001). It was positively correlated with OGTT 2h PG and weight, while negatively correlated with HDL-C(P<0.01);7、 Simultaneously, the intestinal movement time of post-operation were notably reduced(44.5 ± 16.0 min vs 88.7 ± 22.8 min, p<0.01). It was positively correlated with OGTT 2h PG and weight, while negatively correlated with HDL-C(P<0.05);Conclusion1、Utilizing the nuclear imaging measurements, timely and efficiently detections of gastrointestinal motility disorders can be verified in T2 DM patients.2、Gastrointestinal motility, which is strongly linked to blood glucose and lipid level, have been impaired before the gastrointestinal symptoms occurred in T2 DM subjects.3、The gastrointestinal peristalsis time of the diabetes were extremely short after Roux-en-Y gastric bypass surgery, which relate to the improvement of glucolipid metabolism. |
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