Yin RY, Liu ZJ, Yao YQ, Miao RY, Guan HF, Zhang YX, Fang XY, Zhang YJ, Tian JX. Gastrointestinal neuroregulation in diabetic gastroenteropathy: Integrating molecular mechanisms and diagnostic approaches. World J Diabetes 2026; 17(9): 115749 [DOI: 10.4239/wjd.115749]
Corresponding Author of This Article
Jia-Xing Tian, Department of Endocrinology, The Affiliated Hospital of Changchun University of Chinese Medicine, No. 1478 Gongnong Road, Chaoyang District, Changchun 130022, Jilin Province, China. tina_yai@126.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rui-Yang Yin, Yi-Qi Yao, Run-Yu Miao, Yu-Xin Zhang, Yan-Jiao Zhang, Jia-Xing Tian, Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
Zi-Jian Liu, Beijing University of Chinese Medicine, Beijing 100029, China
Hui-Fang Guan, Graduate College, Changchun University of Chinese Medicine, Changchun 130117, Jilin Province, China
Xin-Yi Fang, Graduate College, Beijing University of Chinese Medicine, Beijing 100029, China
Jia-Xing Tian, Department of Endocrinology, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130022, Jilin Province, China
Co-first authors: Rui-Yang Yin and Zi-Jian Liu.
Author contributions: Yin RY, Liu ZJ, Yao YQ, Miao RY, Guan HF, Zhang YX, Fang XY, Zhang YJ, and Tian JX conceptualized the study and designed the research framework; Yin RY and Liu ZJ collected and organized the literature data and they contributed equally to this work as co-first authors; Yin RY, Liu ZJ, and Yao YQ analyzed and interpreted the research findings; Miao RY, Guan HF, and Zhang YX contributed to the discussion of neural regulation mechanisms and diagnostic approaches; Fang XY and Zhang YJ provided technical support for data sorting and figure construction; Tian JX supervised the entire research process, revised the manuscript critically for important intellectual content, and approved the final version to be published. All authors read and agreed to the published version of the manuscript.
Supported by High Level Chinese Medical Hospital Promotion Project, No. HLCMHPP20230CZ40907; CACMS Outstanding Young Scientific and Technological Talents Program, No. ZZ13-YQ-026; GAMIMD Special Fund, No. 2022 LYJSZX12; and CACM-PDP Dose-effect Relationship Research Project, No. 202428-002.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Jia-Xing Tian, Department of Endocrinology, The Affiliated Hospital of Changchun University of Chinese Medicine, No. 1478 Gongnong Road, Chaoyang District, Changchun 130022, Jilin Province, China. tina_yai@126.com
Received: October 24, 2025 Revised: February 28, 2026 Accepted: May 25, 2026 Published online: September 15, 2026 Processing time: 311 Days and 18.2 Hours
Abstract
Diabetic gastroenteropathy (DGP) is a chronic complication of diabetes caused by gastrointestinal (GI) neuropathy. More than 50% of people with diabetes experience GI discomfort, which not only leads to increased glycemic variability but also negatively affects daily quality of life. The sympathetic, vagal and enteric nervous systems and their coordination are necessary to support the normal functioning of GI motility. In addition, neuroimmune processes and the brain-gut axis also play important roles in the complex GI regulatory network. Specifically, diabetes can mediate GI dysfunction through multiple pathways such as chronic low-grade inflammation, neuroimmune disorders, oxidative stress, nerve injury and regulation imbalance, and neuromuscular coupling disorders. Many cytokines including 5-hydroxytryptamine, nitric oxide, vasoactive intestinal peptide, transient receptor potential ankyrin 1, advanced glycation end products, nitric oxide synthase, γ-aminobutyric acid, and short-chain fatty acids. These key neuroregulatory mediators and cytokines participate in multiple pathways to regulate GI peristalsis, thereby promoting the occurrence and progression of DGP. This article aims to systematically analyze the independent and synergistic effects of sympathetic nerve, vagus nerve, and enteric nervous system in DGP, integrate the role of neuroimmunity, gut microbiota-GI-brain axis and other neuropathy-related pathological mechanisms in the pathogenesis of DGP, and integrate the mechanism of key regulatory mediators according to functional categories to comprehensively reveal the multi-level neural regulatory network of DGP. The advantages and limitations of various GI motility detection methods recorded in the existing literature are integrated, aiming to provide valuable insights into the pathophysiology and clinical diagnosis of DGP.
Core Tip: Diabetic gastroenteropathy (DGP) arises from multi-level neural regulatory dysfunction; this study systematically clarifies the synergic dysregulation of the sympathetic-vagus-enteric nervous system, constructs a DGP neural regulatory network, and integrates gastrointestinal motility detection technologies to provide novel insights for DGP’s pathophysiological research and clinical diagnosis.
