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Are GI Symptoms in Diabetics Linked with Poor Glycemic Control?

A higher prevalence of gastrointestinal (GI) symptoms has been reported in patients with diabetes and often is attributed to autonomic neuropathy. With this questionnaire survey of 15,000 Australian adults, researchers obtained population-based data on GI symptoms in people with diabetes.

Sixty percent of mailed questionnaires were completed; of the 8675 respondents, 4.9 percent were diabetic, and, of these, 94.8 percent had type 2 diabetes. The questionnaire assessed 5 symptom complexes and 16 symptoms: abdominal pain or discomfort, early satiety, postprandial fullness, bloating, heartburn, nausea, vomiting, dysphagia, diarrhea or constipation, anal blockage, more than 3 bowel movements per day, fewer than 3 bowel movements per week, lumpy or hard stools, loose or watery stools, urgency, and fecal incontinence. All 16 symptoms were noted significantly more often in diabetics than in controls after controlling for age and sex. The symptoms associated most strongly with diabetes were fecal incontinence (odds ratio, 2.74; 95 percent CI, 1.40-5.37), dysphagia (OR, 2.71; CI, 1.69-4.36), and vomiting (OR, 2.51; CI, 1.12-5.66). The 5 symptom complexes also were found more often in diabetics; the strongest association was with diarrhea symptoms (OR, 2.06; CI, 1.56-2.74). Patient self-assessment of glycemic control was associated with all symptom complexes and was associated moderately to strongly with 12 of the 16 symptoms. In contrast, diabetes type was associated with only 1 symptom, treatment type with only 2, and diabetes duration with only 3.

Comment: These survey results do not rule out autonomic neuropathy as the underlying cause of GI symptoms in diabetics, nor do they exclude the possibility that poor glycemic control is related fundamentally to upper GI dysmotility. Nonetheless, they provide strong evidence that gastroenterologists should recommend tighter glycemic control for diabetic patients with GI symptoms.

— DK Rex

Published in Journal Watch Gastroenterology November 7, 2001

Citation(s):

Bytzer P et al. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: A population-based survey of 15000 adults. Arch Intern Med 2001 Sep 10 161 1989-1996.

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