Gastrointestinal Symptoms in Diabetes: Prevalence, Assessment, Pathogenesis, and Management

Abstract

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", "pathogenesis", "diagnosis", and "management". We restricted the search results to English only. Review papers and meta-analyses are presented as the highest level of evidence where possible followed by randomized controlled trials, uncontrolled trials, retrospective and observational data, and expert opinion.

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

“…Diabetic gastroparesis is a condition characterized by upper gastrointestinal (GI) symptoms and delayed gastric emptying (GE) without gastric outlet obstruction . In addition to potentially debilitating symptoms of nausea, vomiting and upper abdominal pain, the condition may have profound implications for the patients’ ability to regulate their blood glucose levels . Delayed GE is associated with both short‐ and long‐term hyperglycemia .…”

“…1 In addition to potentially debilitating symptoms of nausea, vomiting and upper abdominal pain, the condition may have profound implications for the patients' ability to regulate their blood glucose levels. 2,3 Delayed GE is associated with both short-and long-term hyperglycemia. 4 Gastroparesis may also influence the absorption of oral medications, emphasizing the need for reliable, inexpensive, and accessible tests for measuring GE.…”

Psychosomatic complaints profile in patients with type 2 diabetes: a matched case-control study

“…Our study showed significantly higher scores of gastrointestinal profile (characterized by chest pain, feeling of fullness, nausea, gastroesophageal reflux, pain or discomfort in the abdomen, constipation, diarrhea, bloating or swelling of the abdomen, anal pain) in diabetic patients with anxiety and depression than in controls and other diabetic patients. It is reported that gastrointestinal symptoms occur more frequently in both type 1 and type 2 diabetic patients, who exhibit higher levels of psychosocial problems [36,37]; psychological disorders, including anxiety and depression, are strongly associated with gastrointestinal symptoms [37]. On the other hand, acute changes in blood glucose concentration affect gastrointestinal motor function and increase perceptions of nausea, fullness, and bloating [37,38].…”

“…It is reported that gastrointestinal symptoms occur more frequently in both type 1 and type 2 diabetic patients, who exhibit higher levels of psychosocial problems [36,37]; psychological disorders, including anxiety and depression, are strongly associated with gastrointestinal symptoms [37]. On the other hand, acute changes in blood glucose concentration affect gastrointestinal motor function and increase perceptions of nausea, fullness, and bloating [37,38].…”

Hyperglycaemia-induced epigenetic changes drive persistent cardiac dysfunction via the adaptor p66Shc

“…17 Apart from them, diabetes also increases susceptibility to cognitive decline, cancer, infections and gastrointestinal disease. 18,19 Only 5% of people have type 1 diabetes (T1D). 20 Patients who develop T2D are generally sedentary and obese.…”