Prevalence and clinical determinants of diabetic gastroparesis in type 2 diabetes: a symptom- and scintigraphy-based cross-sectional study

BACKGROUND: Diabetic gastroparesis (DG) is a frequently underdiagnosed complication of type 2 diabetes mellitus (T2D), characterized by delayed gastric emptying without mechanical obstruction. Its nonspecific symptoms often lead to delayed diagnosis and suboptimal management. OBJECTIVE: To assess the prevalence and clinical predictors of DG in patients with T2D, and to investigate the relationship between gastrointestinal symptoms and objectively measured delayed gastric emptying. METHODS: A cross-sectional study included 130 randomly selected patients with T2D attending a tertiary care outpatient clinic. Comprehensive clinical assessment, metabolic profiling, and screening for diabetes-related complications were performed. Symptoms suggestive of DG were assessed using the Gastroparesis Cardinal Symptom Index (GCSI), while delayed gastric emptying was objectively confirmed using gastric emptying scintigraphy (GES) with a standardized low-fat radiolabeled meal. RESULTS: Delayed gastric emptying was observed in 13.1% of participants. Patients with delayed gastric emptying had significantly higher body mass index (BMI), longer duration of diabetes, and poorer glycemic control compared with those without delayed emptying (all p < 0.05). Multivariate analysis identified HbA1c (OR 6.99), BMI (OR 3.89), and duration of diabetes (OR 2.75) as independent predictors of delayed gastric emptying. Symptom-based gastroparesis according to GCSI showed limited agreement with scintigraphic delayed gastric emptying. CONCLUSION: DG appears to be a clinically relevant but potentially underrecognized complication of T2D. Poor glycemic control, obesity, and longer duration of diabetes are associated with delayed gastric emptying. Limited agreement between symptom severity and objectively measured gastric emptying supports the continued role of gastric emptying scintigraphy as the diagnostic reference standard. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov (U.S. National Library of Medicine registry) CLINICAL TRIAL NUMBER: NCT05584462.