Date: {{$ActivityAssignDate}}

Dear Dr. {{$doctorName}},

Subject : Survey to understand diagnosis and management practices of diabetic gastroparesis in Indian Physicians

Gastroparesis is characterized by a combination of cardinal symptoms such as nausea, vomiting, abdominal pain, early satiety, fullness, and bloating and no evidence of mechanical obstruction during gastroscopy, and a delayed 4-hour solid-phase gastric-emptying scan. The most common causes of gastroparesis are neuropathic disorders such as diabetes mellitus, idiopathic, post-vagotomy, and scleroderma among myopathic disorders.

Diabetic gastroparesis is a potential complication that occurs in the setting of poorly controlled diabetes, resulting from dysfunction in the coordination and function of the autonomic nervous system, neurons, and specialized pacemaker cells (interstitial cells of Cajal, ICC). Hyperglycemia (blood glucose greater than 200 mg/dL), commonly seen in poorly controlled diabetes, has been associated with diabetic gastroparesis resulting from neuropathy in the setting of chronic hyperglycemia and does not resolve with improved glycemic control.

Gastroparesis is seen in approximately 4.8% of individuals with type 1 diabetes, 1% of those with type 2 diabetes, and 0.1% of those without diabetes. Although there is a stronger association between type 1 diabetes and gastroparesis, the incidence of type 2 diabetes is much greater, and therefore, gastroparesis associated with type 2 diabetes is seen more frequently.

Gastroparesis typically occurs in patients with a diagnosis of diabetes of at least ten years and is therefore seen more commonly in older individuals with type 2 diabetes. The diagnosis and management of diabetic gastroparesis can be challenging, as it commonly remains undetected prior to the development of complications, and it is often refractory to therapy.

However, there is limited data available on diagnosis and management practices of diabetic gastroparesis. Therefore, this survey is designed to understand the diagnosis and management of diabetic gastroparesis.

If you agree to participate, you will need to provide assessment response, on to the standard data collection form (which we call DCF). A monitor will assist you in verifying and collecting the DCF.

We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.