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  • 1
    ISSN: 1432-0428
    Keywords: Keywords Gastric emptying ; diabetic gastroparesis ; scintigraphy ; breath test ; cardiovascular autonomic function.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Since there is a need for a widely applicable non-invasive test to assess gastric emptying in diabetic patients, we evaluated the sensitivity, specificity, and reproducibility of the [13C]octanoic acid breath test as compared with scintigraphy. Moreover, we examined the relationship between the breath test indices and gastric symptoms, cardiovascular autonomic function, and metabolic parameters. Forty healthy control subjects and 34 diabetic patients were studied. Three indices of gastric emptying, assessed by the breath test, were computed: half-emptying time (t1/2breath), gastric emptying coefficient (GEC), and lag phase. Furthermore, the half-emptying time, measured by scintigraphy (t1/2scint), was calculated and gastric symptoms and cardiovascular autonomic neuropathy (CAN) were scored. The coefficients of variation of day-to-day reproducibility in 10 healthy subjects were 29.6 % for t1/2breath, 7.4 % for GEC, and 46.5 % for lag phase. An abnormal delay for t1/2scint (〉 100 min) or t1/2breath (〉 200 min) was noted in 12 patients. Based on the results for t1/2scint, the sensitivity of t1/2breath and GEC was 75 % and the specificity was 86 %. Both t1/2breath (r s = 0.523; p 〈 0.05) and GEC (r 2 = − 0.594; p 〈 0.05) were significantly associated with the gastric symptom score. A significant relationship to the CAN score was demonstrated for t1/2breath (r s = 0.448; p 〈 0.05), GEC (r s = − 0.467; p 〈 0.05), and t1/2scint (r s = 0.602; p 〈 0.05). There were no significant associations of the breath test indices with the blood glucose levels during the test, HbA1c, age, and duration of diabetes. In patients with abnormal t1/2scint (n = 12) not only was t1/2breath significantly prolonged and GEC reduced, but also the scores of CAN and gastric symptoms were significantly increased as compared with those who had a normal t1/2scint (n = 22). We conclude that the [13C]octanoic acid breath test represents a suitable measure of delayed gastric emptying in diabetic patients which is associated with the severity of gastric symptoms and CAN but not affected by the blood glucose level. [Diabetologia (1996) 39: 823–830]
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0428
    Keywords: Keywords Diabetic cardiovascular autonomic neuropathy ; MIBG scintigraphy ; sympathetic denervation ; autonomic function tests ; glycaemic control.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Diabetic cardiovascular autonomic neuropathy (CAN) has been directly characterized by reduced or absent myocardial [123I]metaiodobenzylguanidine (MIBG) uptake, but there is no information available on the relationship between the myocardial adrenergic innervation defects and long-term glycaemic control. In a prospective study over a mean of 4 years we examined myocardial sympathetic innervation in 12 Type 1 (insulin-dependent) diabetic patients using MIBG scintigraphy (absolute and relative global MIBG uptake at 2 h p. i.) in conjunction with cardiovascular autonomic function tests, QTc interval, and QT dispersion. Six healthy non-diabetic subjects served as controls for the MIBG scintigraphy at baseline. HbA1c was measured twice a year. One patient, in whom MIBG accumulation was reduced maximally, died during follow up. Among the remaining patients 5 had good or borderline glycaemic control (mean HbA1c 〈 7.6 %; Group 1), whereas 6 patients were poorly controlled (mean HbA1c L 7.6 %; Group 2). Absolute global MIBG uptake increased from baseline to follow-up by 260 (−190–540) [median (range) ] cpm/g in Group 1 and decreased by −150 (−450–224) cpm/g in Group 2 (p 〈 0.05 vs Group 1). Relative global MIBG uptake decreased by −1.7 (−3.4–9.4) % in Group 1 and by −4.7 (−17.4–1.3) % in Group 2 (p 〈 0.05 vs Group 1). No differences between the groups were noted for the changes in the automatic function tests, QTc interval, and QT dispersion. In conclusion, long-term poor glycaemic control constitutes an essential determinant in the progression of left ventricular adrenergic dysinnervation which may be prevented by near-normoglycaemia. Evaluation of susceptibility to metabolic intervention may be superior when CAN is characterized directly by MIBG scintigraphy rather than by indirect autonomic function testing. [Diabetologia (1998) 41: 443–451]
    Type of Medium: Electronic Resource
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