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Cisapride Versus Placebo for 8 Weeks on Glycemic Control and Gastric Emptying in Insulin-Dependent Diabetes: A Double Blind Cross-Over Trial¹

Psychophysiology Unit, Department of Surgery (G.St., G.St.-J., U.W.), and Departments of Biomedical Engineering and Physics (H.B.) and Nuclear Medicine (H.B.), University of Vienna, A-1090 Vienna; Department of Medicine I, Krankenanstalt Rudolfstiftung (G.Sc., H.-P.K.) A-1030 Vienna; Ludwig Boltzmann Institute of Nuclear Medicine (H.B.); A-1090 Vienna; and Rehabilitationszentrum der PVA (M.F.), A-2356 Alland, Austria

Address all correspondence and requests for reprints to: Prof. Georg Stacher, M.D., Psychophysiologisches Laboratorium, Waehringer Guertel 18–20, A-1090 Wien, Austria. E-mail: georg.stacher{at}akh-wien.ac.at

In insulin-dependent diabetes mellitus, slow gastric emptying may make absorption unpredictable and foster glycemic instability. Cisapride accelerates emptying, but controlled long term studies are scarce, and effects on glycemic control unknown. We investigated, in patients with insulin-dependent diabetes mellitus and unstable glycemia, the effects of 10 mg cisapride 4 times daily for 8 weeks vs. placebo on glycemic control and gastric emptying under random, cross-over, double blind conditions. In 14 patients with delayed and 9 with nondelayed emptying, blood glucose variability over 2 8-week treatment periods separated by a 4-week wash-out and gastric emptying of a semisolid 1168-kJ meal immediately after the treatment periods were assessed. Cisapride did not affect glycemic control [SD of within-patient mean blood glucose, 4.2 mmol/L ± 0.1 (±SEM) vs. 4.0 ± 0.1 mmol/L after placebo; hemoglobin A_1c, 8.3 ± 0.2% vs. 8.5 ± 0.2%]. Emptying was faster after cisapride than after placebo in 8 of 14 patients with delayed vs. 7 of 9 with nondelayed emptying (P = NS) and in 11 of 15 without vs. 4 of 8 with cardiovascular autonomic neuropathy (P = NS). Autonomic neuropathy prevailed in 7 of 14 patients with delayed and 1 of 9 with nondelayed emptying. Blood glucose immediately before and during assessment of emptying was unrelated to the emptying rate, whereas blood glucose increases over fasting levels were greater with faster emptying (P < 0.002). In conclusion, cisapride’s effects were not different from those of placebo on glycemic control and gastric emptying, it did not differently affect patients with delayed vs. nondelayed emptying, and it slightly accelerated emptying (P = NS) in patients without, but not in those with, cardiovascular autonomic neuropathy. Blood glucose levels before and during assessment of emptying did not affect emptying, but the glucose rise over fasting levels was greater with faster emptying.

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