Diabetic Autonomic Neuropathy Affects Symptom Generation and Brain-Gut Axis

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MARC

Brock, C. (author)

Diabetic Autonomic Neuropathy Affects Symptom Generation and Brain-Gut Axis

Article/chapterEnglish2013

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2013-10-15
American Diabetes Association,2013

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LIBRIS-ID:oai:gup.ub.gu.se/188577
https://gup.ub.gu.se/publication/188577URI
https://doi.org/10.2337/dc13-0347DOI

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Language:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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OBJECTIVELong-term diabetes leads to severe peripheral, autonomous, and central neuropathy in combination with clinical gastrointestinal symptoms. The brain-gut axis thus expresses a neurophysiological profile, and heart rate variability (HRV) can be correlated with clinical gastrointestinal symptoms.RESEARCH DESIGN AND METHODSFifteen healthy volunteers and 15 diabetic patients (12 with type 1 diabetes) with severe gastrointestinal symptoms and clinical suspicion of autonomic neuropathy were included. Psychophysics and evoked brain potentials were assessed after painful rectosigmoid electrostimulations, and brain activity was modeled by brain electrical source analysis. Self-reported gastrointestinal symptoms (per the Patient Assessment of Upper Gastrointestinal Disorder Severity Symptom Index) and quality of life (SF-36 Short Form Survey) were collected.RESULTSDiabetic patients had autonomous neuropathy, evidenced by decreased electrocardiographic R-R interval (P = 0.03) and lower HRV (P = 0.008). Patients were less sensitive to painful stimulation (P = 0.007), had prolonged latencies of evoked potentials (P 0.001), and showed diminished amplitude of the N2-P2 component in evoked potentials (P = 0.01). There was a caudoanterior shift of the insular brain source (P = 0.01) and an anterior shift of the cingulate generator (P = 0.01). Insular source location was associated with HRV assessments (all P < 0.02), and the shift (expressed in mm) correlated negatively with physical health (P < 0.001) and positively with nausea (P = 0.03) and postprandial fullness (P = 0.03). Cingulate source shift was correlated negatively with physical health (P = 0.005) and positively with postprandial fullness (P 0.001).CONCLUSIONSThis study provides evidence for interaction between autonomic neuropathy and peripheral nervous degeneration, as well as changes in dipole sources in diabetic patients with gastrointestinal symptoms. The findings may lead to improved treatment modalities targeting pharmacological neuroprotection or neuromodulation.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Gastroenterologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Gastroenterology and Hepatology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Endokrinologi och diabetes hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Endocrinology and Diabetes hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine hsv//eng
GASTROINTESTINAL SYMPTOMS
ELECTRICAL-STIMULATION
INSULIN-SECRETION
VISCERAL AFFERENT
ACTIVATION
SYSTEM
PAIN
GASTROPARESIS
SEVERITY
PATHWAYS
FRONZO RA
1979
AMERICAN JOURNAL OF PHYSIOLOGY
V237
PE214
SKOV C
1988
ENDOCRINOLOGY
V123
P2009

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Softeland, E. (author)
Gunterberg, VeronicaGothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition (author)
Frokjaer, J. B. (author)
Lelic, D. (author)
Brock, B. (author)
Dimcevski, G. (author)
Gregersen, H. (author)
Simrén, Magnus,1966Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Centrum för personcentrerad vård vid Göteborgs universitet (GPCC),Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,University of Gothenburg Centre for person-centred care (GPCC)(Swepub:gu)xsimrm (author)
Drewes, A. M. (author)
Göteborgs universitetInstitutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition (creator_code:org_t)

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In:Diabetes Care: American Diabetes Association36:11, s. 3698-37050149-59921935-5548

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