Internal Medicine
doi: 10.25005/2074-0581-2021-23-3-324-333
GASTROINTESTINAL MOTOR FUNCTION IN GERIATRIC PATIENTS WITH TYPE 2 DIABETES MELLITUS UNDERGOING JOINT REPLACEMENT

S.I. Kirilina, G.G. Sirota, V.S. Sirota, E.Yu. Ivanova, A.F. Gusev

Anesthesiology and Resuscitation Research Department, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan, Novosibirsk, Russian Federation

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.

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Authors' information:

Kirilina Svetlana Ivanovna
Doctor of Medical Sciences, Principal Researcher, Anesthesiology and Resuscitation Research Department, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan
Researcher ID: R-1482-2019
Scopus ID: 57120169100
ORCID ID: 0000-0002-9282-7296
SPIN: 8632-9224
Author ID: 342227
E-mail: ksi-kln@ngs.ru

Sirota Vadim Sergeevich
Candidate of Medical Sciences, Anesthesiologist-resuscitator, Department of Anesthesiology and Resuscitation, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan
Scopus ID: 57119572000
ORCID ID: 0000-0002-4764-7202
SPIN: 7885-3395
Author ID: 861213
E-mail: niito@niito.ru

Sirota Galina Gennadievna
Anesthesiologist-resuscitator, Department of Anesthesiology and Resuscitation, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan
Scopus ID: 57194542955
E-mail: niito@niito.ru

Ivanova Elena Yurievna
Anesthesiologist-resuscitator, Department of Anesthesiology and Resuscitation, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan
Scopus ID: 57200255404
ORCID ID: 0000-0001-9999-9384
E-mail: niito@niito.ru

Gusev Arkady Fyodorovich
Candidate of Medical Sciences, Scientific Secretary, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan
ORCID ID: 0000-0003-1572-0089
Scopus ID: 57204198723
SPIN: 2904-1730
Author ID: 615403
E-mail: AGusev@niito.ru

Information about support in the form of grants, equipment, medications

The research was carried out in accordance with the research plan of Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan (state registration number – 01201255321). The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Kirilina Svetlana Ivanovna
Doctor of Medical Sciences, Principal Researcher, Anesthesiology and Resuscitation Research Department, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan

630091, Russian Federation, Novosibirsk, Frunze str., 17

Tel.: + 7 (913) 9096057

E-mail: ksi-kln@ngs.ru

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