levosulpiride and Diabetic-Neuropathies

We evaluated the effect of chronic administration of levosulpiride, a prokinetic drug that is a selective antagonist for D2 dopamine receptors, on the glycemic control of IDDM subjects.. The study was performed on 40 long-standing IDDM subjects with clinical signs of autonomic neuropathy and delayed gastric emptying. Gastric emptying time and glycemic parameters (diurnal glycemic profile and HbA1c) were checked under double-blind conditions before and after the administration of levosulpiride at the dosage of 25 mg t.i.d. orally for 6 months, or placebo.. No significant differences were noted in the glycemic and HbA1c values before and after 6 months of placebo administration. In contrast, after 6 months of levosulpiride, glycemic control had improved (HbA1c 6.7 +/- 0.4 and 5.7 +/- 0.3%, P < 0.01; mean daily glycemia 10.9 +/- 0.8 and 8.8 +/- 0.4 mmol/l, P < 0.05, at the start and at the end of the study), while the dosage of injected insulin (0.65 +/- 0.02 IU.kg-1.day-1) and the number of severe hypoglycemic episodes remained unchanged. After 6 months of levosulpiride therapy, the time of gastric emptying was significantly reduced from 321 +/- 14 to 261 +/- 9 min (P < 0.001) and dyspeptic symptoms had improved.. Our results show the importance of gastric emptying in the maintenance of glycemic control and the usefulness of chronic administration of levosulpiride in diabetic subjects with gastroparesis.

Topics: Administration, Oral; Adult; Autonomic Nervous System Diseases; Blood Glucose; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Dopamine Antagonists; Double-Blind Method; Female; Gastric Emptying; Gastroparesis; Glycated Hemoglobin; Humans; Male; Middle Aged; Sulpiride; Time Factors

To investigate if diabetes is more common in drug-induced parkinsonism patients. We performed a hospital-based retrospective case-control study on 44 drug-induced parkinsonism (DIP) patients, 177 Parkinson disease patients, and 176 acute stroke patients matched for age and sex who were seen over the same period at the same hospital. The frequency of diabetes, age-at onset and sex were compared between DIP and IPD or acute stroke. Multivariate analysis showed that patients with diabetes are more frequent in DIP compared with IPD (p<0.001, adjusted OR 5.48; 95% CI, 2.52-11.94). The frequency of diabetes in DIP was comparable to that in acute stroke patients (p=0.16, adjusted OR 0.62; 95% CI, 0.32-1.21). These data suggest that diabetes may be a risk factor for DIP. Drugs with dopamine receptor blocking potency should be avoided in elderly with diabetes.

Topics: Age of Onset; Aged; Contraindications; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Disease Susceptibility; Dopamine Antagonists; Dopamine D2 Receptor Antagonists; Female; Gastroparesis; Humans; Male; Middle Aged; Parkinsonian Disorders; Retrospective Studies; Risk Factors; Sex Distribution; Single-Blind Method; Stroke; Sulpiride