Diabetic gastroparesis (DGP) is a common chronic complication in diabetes patients. About 5% of patients have DGP with the symptoms are anorexia, bloating, early satiety, abdominal pain, and vomiting; for more than 2 weeks. DGP is caused by hyperglycemia that can lead to the degeneration of autonomic nerve cells and axonal demyelination. DGP impairs the absorption and metabolism of oral anti-diabetics, that affects to the increase of glucose variability and causes serious problems in glycemic control, like severe hypoglycemic in an unpredicted period.
Prokinetic agents only alleviate the symptoms of DGP, limited for long-term use due to side effects, and increase the recurrence rate after discontinuing these drugs. Because of that, the nutrition of the degenerative gastrointestinal autonomic nerve may be a new therapeutic direction for DGP.
Mecobalamin, as an active vitamin B12, could be an adjuvant therapy of DGP. This vitamin has abilities to promote the metabolism of major nutrients for autonomic nerve cells in GI system; regenerate nerve cells, axon and its myelin sheath; also reduce motilin hormone (hormone which reduces gastric emptying).
Meta-analysis Study November 2021 by Yao J et al, was done in 1878 patients with diabetic gastroparesis, mean age ranged between 46.8 and 73.1 years old. 962 patients are given 500 mcg Mecobalamin, by oral three times a day or intramuscular injection once a day; combined with prokinetic agents (mosapride/cisapride oral 5-10 mg tid / domperidone oral 10 mg tid / trimebutin maleate oral 200 mg tid). 916 other patients (control group) are only given prokinetic agents. The duration of intervention is for 4-8 weeks. The follow-up of total efficacy rate, gastric emptying rate, serum motilin levels, recurrence rate; were done at the end of intervention. Adverse reaction was evaluated during the duration of intervention.
The results is shown that there is a significant increase of total efficacy rate in mecobalamin group, more than control group, with P < 0.00001. There is not significant difference in total efficacy rate between oral or intramuscular injection route. And there is a significant decrease of serum motilin levels and the recurrence rate, and increase of gastric emptying rate, without increasing adverse reactions; with p < 0.001.
In this study, the reasearcher conclude that the administration of 500 mcg Mecobalamin, by oral three times a day or intramuscular injection once a day, for 4-8 weeks, combined with prokinetic agents (mosapride/cisapride oral 5-10 mg tid / domperidone oral 10 mg tid / trimebutin maleate oral 200 mg tid) in 1878 diabetic gastroparesis patients, more significant than control (only prokinetic agents), in increasing total efficacy rate and gastric emptying rate, and also decreasing serum motilin and the recurrence rate, without increasing adverse reactions; with p values are p < 0.00001, p < 0.001, p < 0.001 and p < 0.001.
Image: Illustration (source:1m- freepik.com)
Reference:Yao J, Peng B, Gong X, Shi X, Fan S, Chen Q. Efficacy and safety of mecobalamin combined with prokinetic agents in the treatment of diabetic gastroparesis: A meta-analysis. Iran J Public Health. Nov 2021; 50(11): 2161-71
