Islet Autoantibodies in T2DM Patients with Gastroparesis
While gastroparesis in type 1 diabetes mellitus (T1DM) patients is well recognized as a long term complication of diabetes mellitus, gastroparesis is being increasingly diagnosed in type 2 diabetes (T2DM). Our overall hypothesis is that T2DM who develop gastroparesis are more likely to have an autoimmune form of the disease, i.e. latent autoimmune diabetes in adults (LADA), more closely related to T1DM than those who do not. This will be investigated through the following three specific aims. Aim 1. 1a) Determine the prevalence of islet autoantibodies (anti-glutamic acid decarboxylase-65 [GAD65] antibody, anti-islet cell antibody, anti-insulin antibody) in T2DM patients with gastroparesis. 1b) Compare the prevalence of islet autoantibodies in symptomatic T2DM patients with and without delayed gastric emptying. Aim 2. 2a) Determine the gastroparesis phenotypic profile (gastric emptying times and gastroparesis symptoms as determined by the Gastroparesis Cardinal Symptoms Index [GCSI]) of T2DM gastroparesis patients having islet autoantibodies. 2b) Compare the gastroparesis symptoms and rate of gastric emptying of T2DM gastroparesis patients with islet autoantibodies to T2DM gastroparesis patients without islet autoantibodies and to T1DM with gastroparesis. Aim 3. 3a) Determine the diabetic phenotypic profile (body weight, insulin sensitivity measured by HOMA-IR, C peptide level, and glucose control measured by fasting glucose, fructosamine level, and A1c) of T2DM gastroparesis patients having islet autoantibodies. 3b) Compare the diabetic phenotypic profile of T2DM gastroparesis patients with islet autoantibodies to patients with T2DM gastroparesis patients without islet autoantibodies and to T1DM with gastroparesis. Through these studies on islet autoantibodies in diabetic patients with gastroparesis, we hope to gain insight in the phenotypic characteristics of this complication of diabetes - diabetic gastroparesis. Identification of patients with T2DM with gastroparesis who have islet autoantibodies, representing LADA, may also have importance in their disease management. It has been suggested that LADA patients should be treated with insulin earlier, or perhaps with immune modulation, as this is thought to preserve beta cell function and improve outcomes.

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