SIGNIFICANT EFFECT OF LOWER GASTROINTESTINAL SYMPTOMS IN THE QUALITY OF LIFE AND GLYCEMIC CONTROL IN TYPE I DIABETES PATIENTS QR code (original) (raw)
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Gastrointestinal Symptoms in Diabetes: Prevalence, Assessment, Pathogenesis, and Management
Diabetes care, 2018
If you haven't measured something, you really don't know much about it.-Karl Pearson (attributed)Gastrointestinal (GI) symptoms represent an important and often unappreciated cause of morbidity in diabetes, although the significance of this burden across the spectrum of patients and the underlying pathophysiology, including the relationship of symptoms with glycemic control, remain poorly defined. The relevance of GI symptoms and the necessity for their accurate assessment have increased with the greater focus on the gut as a therapeutic target for glucose lowering. This review addresses the prevalence, assessment, pathogenesis, and management of GI symptoms in diabetes, beginning with broad principles and then focusing on specific segments of the GI tract. We initially performed a literature search of PubMed by using synonyms and combinations of the following search terms: "gastrointestinal symptoms", "diabetes", "prevalence", "pathogenesi...
Predictors of turnover of lower gastrointestinal symptoms in diabetes mellitus
The American journal of gastroenterology, 2002
Both the natural history of GI symptoms and factors influencing symptom turnover in diabetes mellitus are unknown. We aimed to determine the natural history of GI symptoms in diabetes mellitus over a 3-yr period. Subjects with predominantly Type 2 diabetes on the mailing list of Diabetes Australia were recruited and completed a validated questionnaire (n = 892); of these, 64% completed the questionnaire again 3 yr later. Subjects were classified as never having GI symptoms (abdominal pain, constipation, diarrhea, fecal incontinence), fluctuating (only on one survey), or persistent symptoms. Symptoms more often fluctuated than persisted, but the prevalence at recruitment and 3 yr later was similar. Predictors of symptom turnover varied. In a multivariate model, abnormal sweating and diabetic foot problems predicted symptom turnover for abdominal pain (OR = 2.01, 95% CI = 1.07-3.76 and 2.54, 1.23-5.24, respectively), and paresthesiae ("pins and needles") and foot problems pr...
2007
To compare the GI symptoms in diabetic patients with controls and its relationship with the complications, duration of diabetes and glycaemic control. Methods: Consecutive patients were prospectively enrolled in to two groups. Group I (diabetic patients) and Group II (non-diabetic, Controls). Patient's characteristics, demographic profiles and GI symptoms were evaluated on a questionnaire. Groups were compared for differences in various GI symptoms. Group I was further analyzed for the relationship between GI symptoms with complications, duration of diabetes and glycaemic control. Results: A total of 514 patients were enrolled 250 were diabetics (group I) and 264 were non-diabetics (group II). Mean age was 51.8 + 10.6 years and 50.2 + 9.2 years in groups i and ii respectively. All GI symptoms; heartburn, dyspepsia, bowel related abdominal pain, diarrhea, constipation, and faecal incontinence were significantly more in diabetics than controls (P<. 05). The presence of diabetic neuropathy, retinopathy and HbA1c of >7 were significantly (P <. 05) related to GI symptoms. Duration of diabetes (>10 years) was not found significantly linked to GI symptoms. Conclusions: GI symptoms in diabetics were more frequent then control subjects and were significantly associated with poor glycaemic control, neuropathy and retinopathy but not with duration of diabetes. Number of GI symptoms increases with the severity of poor glycaemic control in diabetic patients (JPMA 57:345:2007).
The American journal of gastroenterology, 2002
Diabetes mellitus is associated with an increased prevalence of GI symptoms, but the mechanisms underlying symptoms are poorly defined and controversial. We aimed to determine whether there is a relationship between GI symptoms and both diabetic complications and glycemic control. We performed a cross-sectional questionnaire study of 1101 subjects with diabetes mellitus recruited from outpatient clinics (n = 209) and the community (n = 892). Data on eight GI symptom groups, complications of diabetes (retinopathy, neuropathy, nephropathy), and self-reported glycemic control were obtained from a validated questionnaire. Glycated hemoglobin was measured in 463 of the subjects, The association between diabetic complications, glycemic control, and GI symptoms was assessed using logistic regression analysis, adjusted for demographic and clinical factors. Of the 1101 subjects, 57% reported at least one complication. Diabetic complications were independently associated with both symptom com...
Gastroenterology, 2000
It has been suggested that intramyocellular diglycerides may be associated with insulin resistance and thus may be linked to the pathophysiology of diabetes. We aimed to investigate intramyocellular diglyceride as well as triglyceride levels in diabetic subjects and to explore a possible association with glycemic control. The participants of the study were 30 obese subjects stratified according to the presence of diabetes into nondiabetic obese (n = 19) and diabetic obese (n = 11). Intramyocellular triglycerides and diglycerides were determined in biopsies from the vastus lateralis muscle under fasting conditions. Glycemic control and insulin resistance were assessed by an oral glucose tolerance test and the homeostatic model, respectively. Higher levels of intramyocellular triglycerides were observed in the diabetic obese group compared with the nondiabetic obese group (66.67 ± 23.75 vs 18.35 ± 4.42 nmol·mg −1 dry tissue, respectively; P b .05). Diglyceride levels were not significantly different between the study groups (1.65 ± 0.27 vs 1.94 ± 0.65 nmol·mg −1 dry tissue, respectively). Monounsaturated fatty acids represented the major constituent of intramyocellular triglycerides in both groups, whereas diglycerides contained mainly saturated fatty acids. A significant correlation was found between intramyocellular levels of triglycerides, but not diglycerides, and glycemic control, expressed as the area under the glucose curve (r = 0.417, P b .05). No correlations were found between intramyocellular levels of both lipid classes and insulin resistance. Our data support a relationship between glycemic control and intramyocellular triglycerides, but not diglycerides. The total flux of fatty acids toward esterification may be a much more important factor in the pathophysiology of diabetes.
Prevalence of Gastroparesis in Type 1 Diabetes Mellitus and its Relationship to Dyspeptic Symptoms
2010
Background and Aim: Gastroparesis and/or dyspeptic symptoms occur in around 50% of type 1 diabetic patients. The aim of our study was to evaluate the prevalence of gastroparesis in patients with type 1 diabetes using 13 Coctanoic acid breath test ( 13 C-OBT) and the relationship between dyspeptic symptoms and gastric emptying. Methods: Gastric emptying of solids was evaluated prospectively in euglycemic conditions in 69 type 1 diabetic patients (male/female: 36/33; mean age 49.5 ± 14.2 years; mean duration of diabetes 20.4 ± 8.2 years) and 40 healthy volunteers (male/female 17/23; mean age 34.3 ± 16 years) using 13 C-OBT. Dyspeptic symptoms, autonomic nerve function and Helicobacter pylori (H. pylori) status were assessed. Results: Solid gastric emptying was slower in diabetic patients (T1/2=125.36 ± 31.5min) than in healthy subjects (T1/2=88.5 ± 27.3 min) (p<0.05). Gastric emptying was slower in diabetic female compared to diabetic male patients (p<0.05). Body mass index (BMI) was the only independent predictor for delayed solid gastric emptying in a logistic regression model testing HbA1c, BMI, age, diabetes duration, H. pylori status, peripheral neuropathy, retinopathy, nephropathy, and autonomic neuropathy. Abdominal bloating and upper abdominal pain were associated with delayed gastric emptying. Conclusions: We found that 33.7% of type 1 diabetic patients had delayed gastric emptying that correlated with female gender, increased BMI, abdominal bloating and upper abdominal pain.