Gastroparesis and Hybrid Closed-Loop Systems

August 18, 2021

Sometimes, despite all the hard work and attempt to stay healthy, diabetes can cause complications. One of those complications is called gastroparesis, which is a type of neuropathy that causes delayed emptying of the stomach.1,2 It causes severe symptoms such as nausea, vomiting and feeling full after very little is eaten, as well as causing issues with blood glucose levels.1,2

Since the food consumed is not absorbed as effectively as without the condition, it causes significant challenges with matching insulin dosing to the food eaten.1 One of the big challenges is erratic highs and lows after insulin is taken, which also causes more distress to the person with diabetes (PWD).1

Given the abundance of data showing that hybrid-closed loop systems improve glycemic control and quality of life, the researchers at Cambridge University reviewed and analyzed the closed loop data for seven patients with type 1 diabetes and gastroparesis.1 The results were very promising showing an increase in the time in range, defined as 3.9 – 10.0 mmol/l (70-180 mg/dL), from 26% to 58.4% on average.1

The hybrid closed loop (HCL) system also decreased the time spent with high blood glucose levels, >10.0 mmol/L (>180 mg/dL), from 72.6% to 40.1%.1 Although it is still not clear whether improving glycemic control can help improve outcomes or symptoms from gastroparesis, it can reduce risks for other complications and improve quality of life.1

One of the systems used by PWD with gastroparesis includes an option for “slowly absorbed meal” built into the algorithm. 1 The same effects can also be achieved by using an extended bolus and both are helpful in managing the blood glucose after meals for people with gastroparesis.1 This same method can be used when matching insulin to meals with higher fat and protein contents and can be done with open loop systems as well.3

It can be hard to talk about complications for most PWD and their loved ones, but it’s a reality many people face in their lifetime. Much like managing diabetes, having technologies, medications, and support are key to managing complications. More research is needed on diabetes and gastroparesis, because very little data is available on how to manage blood glucose levels with gastroparesis.1

CWD has a large collection of questions that have been submitted through our CWD Answers section, and there are many that have been asked and answered about diabetes complications. You can also ask a question on our CWD answers’ page.

If you or someone you know has gastroparesis, you can search for active clinical trials for people with diabetes and gastroparesis at (for studies in the United States).

  1. Hybrid Closed-loop to Manage Gastroparesis in People with Type 1 Diabetes: a Case Series
  2. Gastroparesis – Cleveland Clinic
  3. Bolusing for Fat and Protein

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES