Gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus

AIM To unravel relationships between gastrointestinal (GI) symptoms impairing quality of life (QOL) and clinical profiles of diabetes mellitus (DM) patients. METHODS We enrolled 134 outpatients with type 2 DM. Mean age was 64.7 years, mean body mass index was 24.7 kg/m2, mean glycated hemoglobin was 7.1%, and mean DM duration was 13.7 years. GI symptom-related QOL was determined using the Izumo scale, based on five factors, i.e., heartburn, gastralgia, postprandial fullness, constipation and diarrhea. The sum of scores obtained for the three questions in each domain was calculated, and subjects with a score of 5 or higher were considered to be symptomatic with impaired QOL. JMP Clinical version 5.0 was used for all statistical analyses. RESULTS Lower abdominal symptoms were found to be more frequent than those affecting the upper abdomen. Diabetic duration and medications showed associations with GI symptoms. We identified differences in peak prevalences of the five symptoms. Gastralgia (P = 0.02 vs 10-14 years) and total GI symptoms (P = 0.01 and P = 0.02 vs 5-9 years and 10-14 years, respectively) peaked at a diabetes duration of 15-19 years. Heartburn (P = 0.004) and postprandial fullness (P = 0.03) tended to increase with disease duration. Constipation and diarrhea showed bimodal peaks, with the first early and the second late (e.g., P = 0.03 at 15-19 years vs 10-14 years for diarrhea) in the disease course. Finally, GI symptoms showed clustering that reflected the region of the GI tract affected, i.e., constipation and diarrhea had similar frequencies (P < 0.0001). CONCLUSION Our study highlights the importance of questioning patients about QOL impairment due to abdominal symptoms, especially in the early and the late periods of diabetes.