Published online Sep 28, 2017. doi: 10.3748/wjg.v23.i36.6694
Peer-review started: December 15, 2016
First decision: February 23, 2017
Revised: March 12, 2017
Accepted: June 1, 2017
Article in press: June 1, 2017
Published online: September 28, 2017
Processing time: 284 Days and 19.3 Hours
To unravel relationships between gastrointestinal (GI) symptoms impairing quality of life (QOL) and clinical profiles of diabetes mellitus (DM) patients.
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.
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).
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.
Core tip: We describe the results of a questionnaire survey of 134 type 2 diabetes mellitus outpatients experiencing gastrointestinal symptoms. The novel finding is that symptom frequencies differed among disease durations and according to affected gastrointestinal regions. Lower abdominal symptoms not only manifested during the late but also in the early stage of diabetes when there were no organ complications related to this disease. Our study highlights the importance of not underestimating gastrointestinal symptoms and of questioning patients about quality of life impairment due to abdominal symptoms, especially in both the early period and after a diabetes duration of 10 or even 15 years.