Long-term cisapride treatment improves diabetic gastroparesis but not glycaemic control

Abstract

Background: In patients with diabetic gastroparesis, delayed food delivery to the intestine may become a major obstacle to post-prandial glycaemic control. Aim: To investigate whether cisapride accelerates gastric emptying in the long term or improves diabetes control in patients with diabetic gastroparesis. Methods: Eighty-five patients with long-standing insulin-dependent diabetes mellitus (glycosylated haemoglobin (HbAlc) > 7.0%), dyspepsia and diabetic neuropathy were tested for impaired gastric emptying of solids by the 13C-octanoate breath test. Nineteen of these patients with severe diabetic gastroparesis (i.e. t1/2 > 170 min) were randomly treated with 10 mg cisapride t.d.s. (n = 9) or placebo (n = 10) for 12 months. Thereafter, the breath test, dyspeptic symptoms and HbAlc values were reassessed. Results: Half emptying times in nine patients with diabetic gastroparesis were significantly shortened by cisapride (175 ± 46 min vs. 227 ± 40 min; P < 0.03). Half emptying times in the 10 patients taking placebo did not change (205 ± 37 min vs. 211 ± 36 min, P = 0.54). Cisapride significantly reduced dyspepsia (score: 4.1 ± 1.6 vs. 2.0 ± 0.5, P = 0.002). HbAlc values after 12 months of treatment were not different (cisapride: 7.7 ± 0.4% vs. 7.6 ± 0.9%, P = 0.76; placebo: 7.5 ± 0.6% vs. 7.6 ± 1.5%, P = 0.89). Conclusions: Prokinetic treatment with cisapride accelerates gastric emptying of solids and improves dyspeptic symptoms in diabetic gastroparesis. Glycaemic control, however, is not affected by cisapride.