GASTROINTESTINAL MOTOR FUNCTION IN GERIATRIC PATIENTS WITH TYPE 2 DIABETES MELLITUS UNDERGOING JOINT REPLACEMENT

Abstract

Objective: To study the pattern of the gastrointestinal (GI) motility and determine the relationship between the indicators of glycemic profile, clinical manifestations of GI syndromes and the type of GI motility impairment in geriatric patients with type 2 diabetes mellitus (T2DM) during joint replacement surgery. Methods: The study involved 350 patients over 70 years old (76±5.0) with osteoarthritis (OA) and concomitant T2DM. GI motility was assessed using computer-aided phonoenterography (CPEG). In addition, monitoring of the level of glycemia (GL) was carried out. To determine correlations between the GL during CPEG and the level of glycated hemoglobin with the GI motility indicators, the assessment points of the study were specified as: 1) with empty stomach; 2) enteral nutrition by sipping; 3) administration of gastrokinetics. Results: The CPEG method revealed three types of intestinal peristalsis (with weak, moderate and strong wave types). The relationship between GI motility and GL was characterized by an «intestinal peak factor» (IPF) coefficient. It was found that the clinical manifestations of GI syndromes correlate with the objective indicator of the GI motility, such as IPF (r=0.6; p=0.012); and GL (r=0.54; p=0.021). It was shown that when taking a standard nutritional formula for nutritional support, the GI motility decreases while the level of glycemia increases, despite the timely taken antihyperglycemic drugs. Therefore, it is necessary to prescribe a specialized nutritional mixture and gastrokinetics, which accelerate the evacuation from the upper gastrointestinal tract (GIT). A correlation was found between GL and GI motility (r=0.49; p<0.001). Conclusion: Detection and assessment of the GI motility disorders, as well as GL monitoring, allow to determine the treatment tactics. Thus, the correction of GI motility impairment using early enteral nutrition by sipping with intake of gastrokinetics is justified. This diagnostic concept provides an understanding of the processes occurring in chronic intestinal failure (CIF) in geriatric patients with T2DM, and allows to choose rational therapy. Keywords: Motility, gastrointestinal tract, coxarthrosis, gonarthrosis, joint replacement, old age, type 2 diabetes mellitus.