Early detection of gastroparesis with diabetic ketoacidosis as initial manifestation: A case-control study

Gastroparesis may repeatedly induce diabetic ketoacidosis (DKA), and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms. If DKA is accompanied by gastroparesis, patients present with persistent gastrointestinal symptoms without relief and may even experience recurrent DKA. Misdiagnosis results in poor treatment outcomes and prognosis. We hypothesized that biomarkers or screening tools can be identified by comparing the clinical data between DKA alone and DKA + gastroparesis to facilitate early screening.

To achieve early detection and diagnosis of DKA + gastroparesis to enable early treatment aimed at relieving gastrointestinal symptoms and preventing re-induction of DKA.

We conducted a case-control study in which 15 patients hospitalized for DKA at the Endocrinology Department of Peking Union Medical College Hospital and diagnosed with DKA and gastroparesis between December 1999 and January 2023 (DKA + gastroparesis group) were included. Then, we selected 60 DKA patients without DKA as a control group (DKA alone group) based on gender, age, disease course, and diabetes subtype in a 1:4 matching ratio. Clinical manifestations and physical and laboratory examination results were statistically compared between the groups.

The DKA + gastroparesis group was composed of nine males and six females, with a mean age of 35 ± 11 years, while the DKA alone group included 34 males and 26 females, with a mean age of 34 ± 17 years. In the DKA + gastroparesis group, urine ketone levels normalized, while gastrointestinal symptoms persisted despite treatment, and the tests indicated lower glycosylated hemoglobin levels (HbA1c; 7.07% vs 11.51%, P < 0.01), largest amplitude of glycemic excursions (5.86 vs 17.41, P < 0.01), standard deviation of blood glucose (SDBG; 2.69 vs 5.83, P < 0.01), and coefficient of blood glucose variation (0.31 vs 0.55, P = 0.014) compared with the DKA alone group. Probable gastroparesis was considered at HbA1c < 8.55%. Besides, the patients in the DKA + gastroparesis group had lower body mass index (19.28 kg/m² vs 23.86 kg/m², P = 0.02) and higher high density lipoprotein cholesterol level (2.34 mmol/L vs 1.05 mmol/L, P = 0.019) compared to the DKA alone group, but no difference was observed in the remaining lipid profiles between the two groups.

Gastroparesis should be considered in DKA patients who fail to have improved gastrointestinal symptoms after ketone elimination and acidosis correction, particularly when the HbA1c level is < 8.55%.