Gastrointestinal autonomic neuropathy in patients with type 2 diabetes mellitus: features of diagnosis and treatment

Diabetes mellitus (DM) type 2 is one of the components of metabolic syndrome. One of the most common complications of type 2 diabetes is diabetic neuropathy, which results in damage to peripheral and/or autonomic nerve fibers. Disorders of the autonomic nervous system - diabetic autonomic neuropathy (DAN)-can occur in up to 60% of patients. One form of GAN is gastrointestinal autonomic neuropathy (GAN). There is no exact information about its prevalence due to the complexity of diagnosis, but according to some data, symptoms occur in half of patients with diabetes. The main manifestations of GAN are esophageal motility disorders (heartburn, reflux), gastroparesis (nausea, vomiting, feeling of fullness), intestinal motility disorders (diarrhea, constipation), anorectal dysfunction (fecal incontinence). Impaired gastrointestinal motility, in particular gastroparesis, leads to changes in the pharmacokinetics of oral glucose-lowering drugs, which reduces their effectiveness. And in patients receiving insulin therapy, impaired movement of food through the gastrointestinal tract can lead to hypoglycemia. In this regard, identifying and treating manifestations of GAN is an important aspect of managing a patient with type 2 diabetes. Diagnosis of GAN should be aimed at excluding other causes of gastrointestinal disorders and includes, depending on the clinical manifestations, fibrogastroduodenoscopy, barium radiography, colonoscopy, etc. The “gold standard” for diagnosing gastroparesis is considered to be measuring gastric emptying using scintigraphy of digested solids, but due to the high cost and complexity of the procedure, this method is not used in routine practice. The main therapeutic measures in the management of patients with diabetes and GAN are glycemic compensation, compliance with nutritional recommendations, treatment of neuropathy and symptomatic therapy.