High burden of GI symptoms in patients with type 1 diabetes
medwireNews: People with type 1 diabetes are approximately twice as likely to experience gastrointestinal (GI) symptoms as those without, and these symptoms are associated with poor glycemic control and quality of life (QoL), study results suggest.
Therefore, “[a] low threshold for investigating gastrointestinal symptoms in people with type 1 diabetes may lead to improvement in glycemic control and quality of life,” John Leeds (Royal Hallamshire Hospital, Sheffield, UK) and colleagues write in BMJ Open Diabetes Research and Care.
The researchers found that 62.3% of 706 type 1 diabetes patients, aged an average of 41.9 years, who took part in the study reported GI symptoms, compared with 47.0% of 604 controls without diabetes, giving a significant odds ratio of 1.9.
And the majority of individual GI symptoms occurred significantly more frequently in participants with versus without diabetes, including diarrhea (6.1 vs 2.6%), constipation (8.5 vs 3.3%), alternating bowel habit (8.8 vs 4.5%), and abdominal pain (17.7 vs 13.4%).
Diabetes patients with diarrhea, alternating bowel habit, or abdominal pain had significantly poorer glycemic control than age- and sex-matched patients with diabetes and no GI symptoms, with glycated hemoglobin levels of 8.2% versus 7.3%, 8.5% versus 7.9%, and 8.3% versus 7.7%, respectively. QoL scores in most domains were also significantly worse among those reporting GI symptoms.
Noting that the association between GI symptoms and poor glycemic control “leads to a ‘chicken and egg’ hypothesis,” the researchers say that “it is impossible to determine whether gastrointestinal symptoms lead to poor glycemic control, or whether poor glycemic control leads to gastrointestinal symptoms.” They also caution that the majority of symptoms were self-reported and not formally diagnosed, and that their study was “not designed to establish mechanisms by which people with type 1 diabetes acquire gastrointestinal symptoms.”
However, Leeds and team point out that further investigation of 94 patients with diarrhea established a cause of the symptoms and led to a change in management in almost three-quarters. In all, 14 of these patients were found to have celiac disease, while 10 had inflammatory bowel disease and six had exocrine pancreatic disease.
These findings suggest that “[i]nvestigation of diarrhea in people with type 1 diabetes leads to a high yield of treatable conditions,” and therefore diabetes care “should encompass gastrointestinal assessments routinely.”
The researchers also identified some associations between GI symptoms and self-reported diabetes complications. For example, compared with patients who did not report any GI symptoms, neuropathy was significantly more common among those with any change in bowel habit, while retinopathy occurred significantly more frequently among patients with diarrhea or alternating bowel habit, but not among those with constipation or abdominal pain.
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