Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2025; 31(15): 101695
Published online Apr 21, 2025. doi: 10.3748/wjg.v31.i15.101695
Early detection of gastroparesis with diabetic ketoacidosis as initial manifestation: A case-control study
Li Han, Qing-Yi Peng, Jie Yu, Yi-Wen Liu, Wei Li, Fan Ping, Hua-Bing Zhang, Yu-Xiu Li, Ling-Ling Xu
Li Han, Qing-Yi Peng, Jie Yu, Yi-Wen Liu, Wei Li, Fan Ping, Hua-Bing Zhang, Yu-Xiu Li, Ling-Ling Xu, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Co-first authors: Li Han and Qing-Yi Peng.
Author contributions: Han L and Peng QY contributed equally to this work as co-first authors. Han L and Xu LL selected the topic and designed this study; Han L, Yu J, Liu YW, Ping F, Li W, Zhang HB, and Li YX reviewed the medical records, chose patients who met the inclusion criteria, and collected the data; Han L analyzed the data and drew an interesting conclusion; Han L and Peng QY made joint efforts to write the main manuscript text; Xu LL revised the manuscript. All authors read and approved the final manuscript.
Supported by National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-B-015; and the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences, No. 2021-I2M-C&T-B-003.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Review Committee of Peking Union Medical College Hospital (No. K4854).
Informed consent statement: Since this was a retrospective study and the data were anonymous, informed consent was waived by the Ethics Committee of Peking Union Medical College Hospital.
Conflict-of-interest statement: The authors declare that they have no competing interests to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The dataset generated and/or analyzed during the current study are not publicly available to protect the privacy of the respondents.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ling-Ling Xu, PhD, Professor, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan Street, Beijing 100730, China. llxuwsh@163.com
Received: September 23, 2024
Revised: January 21, 2025
Accepted: March 21, 2025
Published online: April 21, 2025
Processing time: 206 Days and 17.5 Hours
Abstract
BACKGROUND

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.

AIM

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

METHODS

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.

RESULTS

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/m2vs 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.

CONCLUSION

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%.

Keywords: Diabetes mellitus; Diabetic ketoacidosis; Diabetic gastroparesis; Early detection; Diagnosis

Core Tip: Persistent gastroparesis can repeatedly trigger diabetic ketoacidosis (DKA) and is difficult to correct. We compared the clinical manifestations and biomarkers between patients with DKA alone and those with DKA + gastroparesis to help promptly detect and diagnose DKA with gastroparesis, relieve gastrointestinal symptoms, and prevent re-induction of DKA. Notably, we found that if patients with DKA present persistent gastrointestinal symptoms without relief, lower glycosylated hemoglobin (HbA1c) levels, lower body mass index, and higher high-density lipoprotein cholesterol levels after ketone elimination and acidosis correction, gastroparesis should be considered in clinical practice, particularly when the HbA1c level is < 8.55%. Furthermore, gastrointestinal examinations should be performed in a timely manner to facilitate diagnosis.