The prevalence of small intestinal bacterial overgrowth (SIBO) in adult patients with type 1 diabetes and relationship with metabolic control and the presence of chronic complications of the disease

Abstract

INTRODUCTION Gastrointestinal symptoms may occur in 50% to 70% of patients with diabetes. OBJECTIVES The aim of this study was to evaluate the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with diabetes, as well as the relationship between SIBO and metabolic control of diabetes and the presence of chronic complications of the disease. PATIENTS AND METHODSThe study group included 148 patients with type 1 diabetes, treated in the years 2013-2015. The control group consisted of 41 healthy volunteers. The presence of SIBO was assessed with a noninvasive breath test using 20 g of lactulose suspended in 200 ml of water, with the assessment of exhaled hydrogen concentrations. The measurements were performed at 15-minute intervals in the first hour and at 30-minute intervals in the second hour of the test. A positive result was considered as the output value of exhaled hydrogen of 20 parts per million (ppm) or higher or an increase in the output value of the exhaled hydrogen of 12 ppm during the first 60 minutes of the test. RESULTSWe observed a lower prevalence of SIBO in the study group in comparison with controls (56 patients [37.8%] vs 30 healthy volunteers [73%]; P = 0.006). In the logistic regression model, this association was independent of age, sex, body mass index, cigarette smoking, serum C-reactive protein concentrations, and estimated glomerular filtration rate (odds ratio, 0.26; 95% confidence interval, 0.10-0.68; P = 0.006).CONCLUSIONS The prevalence of SIBO in patients with type 1 diabetes is lower than that in healthy subjects. One of the possible causes might be the beneficial effect of nutritional therapy in patients with diabetes.

Type 1 diabetes mellitus: Complex interplay of oxidative stress, cytokines, gastrointestinal motility and small intestinal bacterial overgrowth

“…In a study by Faria et al, 2013, the prevalence of SIBO was 11.5% which is lower compared to the prevalence of SIBO observed in the present study (22.7% in T1DM patients and 37.5% in T1DM ≥5 years disease duration). In contrast to findings in the present study, recently another study observed lower (37.8%) prevalence of SIBO in adult patients with type 1 diabetes in comparison with controls (73%) although the % of SIBO in patients and controls in their study was higher than observed in the present study. However, the association between hyperglycaemia, oxidative stress, inflammatory cytokines, OCTT, and SIBO in same patients of T1DM has never been studied.…”

Do H. Pylori Status and Small Intestinal Bacterial Overgrowth Determine the Clinical Course of Chronic Active Gastritis in Patients With Type 2 Diabetes Mellitus?

“…Another peculiarity of chronic gastritis in patients with T2DM is commonly diagnosed SIBO (75% vs 41.3% non-diabetic cases). In contrast, some literature data suggest that patients with T1DM are diagnosed with SIBO in 37.8% cases [30]. Such symptoms as bloating, belching and nausea in patients with chronic gastritis and T2DM are significantly associated as with HP infection, as with SIBO, which has been diagnosed in 77.5% HP-positive cases and 66.7% HP-negative cases.…”

The Prevalence of Small Intestinal Bacterial Overgrowth in Diabetes Mellitus: A Systematic Review and Meta-analysis

“…The studies were subgrouped based on the SIBO diagnostic test used. The pooled prevalence of SIBO was 31% (95% CI 18-43%) in six studies [13,14,18,22,24,28] using the LBT and 29% (95% CI 14-43%) in seven studies [12, 19-21, 23, 25, 26] using the GBT. Two studies [27,28] using JACs showed a prevalence of 39% (95% CI 12-66%) (Fig.…”

“…Studies on the relationship between DM and risk of SIBO have yielded inconsistent results. Notably, diabetes patients have been reported to exhibit increased risks of SIBO [12] , but several studies have reported inconsistent results [13][14] . Therefore, we conducted a systematic review and meta-analysis to investigate the relationship between DM and the risk of SIBO by summarizing all of the available data.…”