AIMS: This study evaluates gastrointestinal motility dysfunction in type 2 diabetes patients with and without neuropathy compared to healthy individuals using gastric filling ultrasound. MATERIALS AND METHODS: We enrolled 210 participants: 50 healthy controls, 106 diabetic controls (without neuropathy), and 54 observation patients (with neuropathy). Gastric emptying times and fullness scores were measured at 30 and 60 min post-meal. Small intestinal transit rates were assessed at baseline and 60 min. Gastric capacity and wall thickness were evaluated by ultrasound, while motilin and glucagon levels were measured by ELISA. RESULTS: The observation group showed significantly prolonged gastric emptying vs both control groups (30 min: 75.38 ± 13.49 vs 52.46 ± 11.37 vs 45.96 ± 12.85 min
60 min: 122.53 ± 16.38 vs 84.27 ± 11.44 vs 75.12 ± 10.20 min
all P <
0.002). Gastric fullness scores exhibited similar progressive increases (30 min: 7.45 ± 0.66 vs 5.37 ± 0.75 vs 4.53 ± 0.69
60 min: 6.84 ± 0.51 vs 4.56 ± 0.68 vs 3.72 ± 0.51
P <
0.002). Small intestinal transit was slowest in the observation group (baseline: 3.62 ± 0.21 vs 4.53 ± 0.36 vs 5.36 ± 0.25 cm/min
60 min: 3.05 ± 0.15 vs 4.15 ± 0.50 vs 5.25 ± 0.31 cm/min
P <
0.05). The observation group had significantly reduced gastric capacity (714.68 ± 35.49 vs 875.25 ± 53.66 vs 923.63 ± 39.72 mL) and increased wall thickness (4.16 ± 0.55 vs 3.33 ± 0.42 vs 2.98 ± 0.26 cm) vs other groups (P <
0.002). Hormonal changes included lower motilin (28.44 ± 5.16 vs 45.67 ± 7.33 vs 53.71 ± 8.65 pg/mL) and higher glucagon (382.56 ± 23.62 vs 295.14 ± 11.55 vs 256.86 ± 27.90 pg/mL) in the observation group (P <
0.002). CONCLUSIONS: Gastric filling ultrasound demonstrates progressive gastrointestinal impairment from healthy individuals to diabetic patients, with the most severe dysfunction in neuropathic cases. These objective measures support regular gastrointestinal assessment in diabetes management, particularly for patients developing neuropathy.