Department of Biochemistry, Medical College for Women’s & Hospital, Uttara, Dhaka, Bangladesh
Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
and objectives: Gastrointestinal (GI) disorders
are contributor of increased morbidity and poor quality of life in individuals
with diabetes mellitus (DM). Racial, nutritional and life style may influence
GI disorders to a large extent. Thus, the burden of GI disorders and its
determinants warrant investigation in individual population. Therefore, the
present study was undertaken to explore the types of GI symptoms in Bangladeshi
population with DM for more than 10 years of duration.
This observational study was conducted on patients with DM for more than 10
years of duration at the outpatient department of BIRDEM general hospital from
July 2009 to June 2010. A total of 301 DM patients responded to self-reporting
questionnaire (Bengali adaptation of Rome III diagnostic questionnaire). Then
91 participants were further studied for glycemic status, liver function,
kidney function and basic defects of diabetes through homeostasis model
The median age of 301 study population
was 55 years (range 25 to 84 years) and the male female ratio was 1: 0.74. Out
of 301 DM cases, 273 (90.7%) had GI symptoms. Significantly (p<0.05) higher
number of males (93.6%) had GI symptoms compared to females (86.7%). Among
the clinical conditions, unspecified functional bowel disorder (UFBD) was
present in 88.3% cases, followed by cyclic vomiting syndrome (38.1%) and
functional fecal incontinence (20.9%). Single GI symptom was
present in 123 (45.1%) cases while 32.6%, 12.5% and 9.9% had two, three and
more than three GI symptoms respectively. No significant difference was found in any
biochemical parameter between cases with and without GI symptoms. Multiple logistic regression analysis
revealed sex and residence as poor predictors of UFBD while other
variables did not show any significant relation/risk to UFBD.
A large proportion of patients with long duration of DM had GI symptoms. A comprehensive management of diabetes requires attention to
IMC J Med Sci 2017; 11(2): 56-60
Dr. Shahjada Selim,
Assistant Professor, Department of Endocrinology & Metabolism, Bangabandhu
Sheikh Mujib Medical University, Shahbag,
Dhaka-1000, Bangladesh. Email:firstname.lastname@example.org, email@example.com
(GI) symptoms are more common in patients with diabetes compared to individuals
without diabetes. The pathogenesis of symptoms remains poorly understood. It
has been suggested that symptoms reflect abnormal GI motility as a
manifestation of irreversible autonomic neuropathy. Evidence for this concept,
however, is limited. Studies have implicated duration of diabetes, type of
diabetes treatment, or an increased perception of abdominal distension the as
risk factors for GI symptoms .
the symptoms prominent in the functional gastrointestinal disorders (FGIDs) are
dysfunction of the sensory and/or motor apparatus of the digestive tract .
Various combinations of such dysfunction occur in different regions of the digestive
tract in the FGIDs. The understanding of the origins of this gut sensori-motor
dysfunction is gradually increasing. Inﬂammatory, immunologic, and other
processes, as well as psycho-social factors such as stress, can alter the
normal patterns of sensitivity and motility through alterations in local reflex
activity or via altered neural processing along the brain-gut axis. In this
context, a potential role of genetic factors, early-life influences, enteric
flora, dietary components and autonomic dysfunction have also been considered
in the disease model . Therefore,
the present study was designed to explore the types of GI symptoms and the
related factors in a group of Bangladeshi population with DM of more than 10
years of duration.
Materials and Methods
was conducted at the outpatient department of BIRDEM general hospital from July
2009 to June 2010. It was designed in 2 steps. In step 1, 301 patients with DM
of more than 10 years of duration were included, and in step 2 a subgroup of 91
cases were selected for biochemical analysis. Diabetes mellitus (DM) was
defined as a condition of progressive pancreatic beta cell dysfunction having HbA1C
level ≥6.5% or fasting plasma glucose (FPG) ≥7.0 mmol/l or two-hour plasma
glucose ≥11.1 mmol/l during an OGTT or a random plasma glucose of ≥11.1 mmol/l
in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis
version of Rome III diagnostic questionnaire for the adult functional
gastrointestinal disorders (including alarm questions) and scoring was used
after pretesting . Enrolled
participants were evaluated for their glycemic status, liver function, kidney function and basic
defects of diabetes through homeostasis model assessment . Statistical
analysis was performed using SPSS (Statistical Package for Social Science) software
for Windows version 20. The data were expressed as frequency, mean ± SD
(standard deviation) or median (range) as appropriate. The statistical
significance of differences between the values was assessed by student’s t test
or Mann-Whitney U test as appropriate. Correlation was also analyzed among the
parameters by using Pearson Correlation test. Regression analyses were done by
taking appropriate dependent and independent variables. A p value of
<0.05 was considered statistically significant.
The median age of 301 study population was 55 years and
the age ranged from 25 to 84 years. Male female ratio was 1: 0.74. Out of 301 DM
cases, 273 (90.7%) had GI symptoms. Significantly (p<0.05) higher number of
males (93.6%) had GI symptoms compared to females (86.7%). The rate of GI symptoms
among urban and rural dwellers was 91.3% and 89.8% respectively (Table-1).
Distribution of clinical conditions among the 273 cases with GI symptoms is shown
in Table-2. Among the clinical conditions, unspecified functional bowel
disorder (UFBD) was the most frequent (88.3%), followed by cyclic vomiting
syndrome (38.1%) and functional fecal incontinence (20.9%). Out
of 273 DM cases with GI symptoms, 123 (45.1%) had single symptoms while 32.6%,
12.5% and 9.9% had two, three and more than three GI symptoms respectively.
Table-1:Characteristics of the study groups
compares the biochemical parameters of diabetic patient with and without GI symptoms.
There were no significant differences in any biochemical parameters between
cases with and without GI symptoms. Multiple
logistic regression analysis of
the association of unspecified functional bowel disorder (UFBD) present and absent with variables of
interest is shown in Table-5. Sex and residence, though significant,
were very poor predictors of UFBD. Other variable did not show any significant
relation/risk to UFBD.
Table-2: Distribution of gastrointestinal
symptoms among the study population (n=273)
Table-3: Comparison of biochemical parameters in patients with and without GI
Table-4: Multiple logistic regression analysis of the
association of unspecified functional bowel disorder (UFBD) present and absent with variables of
In the present study, Rome III
diagnostic criteria were used to determine the GI symptoms among the patients
with diabetes mellitus of more than 10 years of duration. Rome III diagnostic criteria
are considered to be one of the up to date instrument in this area for
ascertaining the gastrointestinal symptoms. Over 90% of our study population
had one or more GI symptoms. We found unspecified functional vowel disorder
(UFBD) as the most frequent disorders among the study population (88.3%) which was followed by cyclic vomiting and fecal
incontinence. Studies from USA, Europe and Australia have reported 40% to 55% GI
disorders among patients with diabetes mellitus [7-12]. The effect was shown to
be linked to poor glycemic control but not to duration of diabetes or type of
treatment . But in our study, in contrast to the prevalent concept of
association between glycemic control and GI disorders, no significant
relationship was found between the two variables. In addition to the glycemic
status, no association of GI symptoms with lipidemic status and liver function was
found. Data from other studies [5,12] support the present conclusion that blood
glucose control may not affect GI symptoms in a straight forward way.
Bangladeshi patients with type 2 DM
have functional beta cell deficiency and secretory failure [13,14]. We have
tried to find out whether these basic defects have any association with GI symptoms
or not. No significant association was found between GI symptoms and insulin
secretion and sensitivity from the absolute values of serum C peptide as well
as from the derived values of HOMA% B (a measure of pancreatic β cell secretory function) and HOMA% S (a measure of insulin
The present study, thus, revealed
that a large proportion of Bangladeshi population with DM of long duration had
one or more GI symptoms. Although, it may not be directly related to mortality
in diabetes, it may have considerable impact on the quality of life of patients
with DM. Therefore, attention to GI disorders should be given in planning comprehensive
management of diabetes mellitus.
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