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Open Access 28-03-2024 | Nerve Stimulation | Article

Transcutaneous vagal nerve stimulation for treating gastrointestinal symptoms in individuals with diabetes: a randomised, double-blind, sham-controlled, multicentre trial

Authors: Ditte S. Kornum, Davide Bertoli, Huda Kufaishi, Anne-Marie Wegeberg, Tina Okdahl, Esben B. Mark, Katrine L. Høyer, Jens B. Frøkjær, Birgitte Brock, Klaus Krogh, Christian S. Hansen, Filip K. Knop, Christina Brock, Asbjørn M. Drewes

Published in: Diabetologia | Issue 6/2024

Abstract

Aims/hypothesis

Diabetic gastroenteropathy frequently causes debilitating gastrointestinal symptoms. Previous uncontrolled studies have shown that transcutaneous vagal nerve stimulation (tVNS) may improve gastrointestinal symptoms. To investigate the effect of cervical tVNS in individuals with diabetes suffering from autonomic neuropathy and gastrointestinal symptoms, we conducted a randomised, sham-controlled, double-blind (participants and investigators were blinded to the allocated treatment) study.

Methods

This study included adults (aged 20–86) with type 1 or 2 diabetes, gastrointestinal symptoms and autonomic neuropathy recruited from three Steno Diabetes Centres in Denmark. Participants were randomly allocated 1:1 to receive active or sham stimulation. Active cervical tVNS or sham stimulation was self-administered over two successive study periods: 1 week of four daily stimulations and 8 weeks of two daily stimulations. The primary outcome measures were gastrointestinal symptom changes as measured using the gastroparesis cardinal symptom index (GCSI) and the gastrointestinal symptom rating scale (GSRS). Secondary outcomes included gastrointestinal transit times and cardiovascular autonomic function.

Results

Sixty-eight participants were randomised to the active group, while 77 were randomised to the sham group. Sixty-three in the active and 68 in the sham group remained for analysis in study period 1, while 62 in each group were analysed in study period 2. In study period 1, active and sham tVNS resulted in similar symptom reductions (GCSI: −0.26 ± 0.64 vs −0.17 ± 0.62, p=0.44; GSRS: −0.35 ± 0.62 vs −0.32 ± 0.59, p=0.77; mean ± SD). In study period 2, active stimulation also caused a mean symptom decrease that was comparable to that observed after sham stimulation (GCSI: −0.47 ± 0.78 vs −0.33 ± 0.75, p=0.34; GSRS: −0.46 ± 0.90 vs −0.35 ± 0.79, p=0.50). Gastric emptying time was increased in the active group compared with sham (23 min vs −19 min, p=0.04). Segmental intestinal transit times and cardiovascular autonomic measurements did not differ between treatment groups (all p>0.05). The tVNS was well-tolerated.

Conclusions/interpretation

Cervical tVNS, compared with sham stimulation, does not improve gastrointestinal symptoms among individuals with diabetes and autonomic neuropathy.

Trial registration

ClinicalTrials.gov NCT04143269

Funding

The study was funded by the Novo Nordisk Foundation (grant number NNF180C0052045)

Graphical Abstract

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Title: Transcutaneous vagal nerve stimulation for treating gastrointestinal symptoms in individuals with diabetes: a randomised, double-blind, sham-controlled, multicentre trial
Authors: Ditte S. Kornum
Davide Bertoli
Huda Kufaishi
Anne-Marie Wegeberg
Tina Okdahl
Esben B. Mark
Katrine L. Høyer
Jens B. Frøkjær
Birgitte Brock
Klaus Krogh
Christian S. Hansen
Filip K. Knop
Christina Brock
Asbjørn M. Drewes
Publication date: 28-03-2024
Publisher: Springer Berlin Heidelberg
Keyword: Nerve Stimulation
Published in: Diabetologia / Issue 6/2024
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-024-06129-0

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