Association of Gastrointestinal Symptoms with Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Abstract

Objective: To assess how often gastrointestinal (GI) symptoms (constipation, diarrhoea, dyspepsia and bloating) occur in type 2 diabetes mellitus (T2DM) and whether they are related to glycemic control or diabetes duration.

Materials and Methods: This was a cross-sectional study which was carried out in the Department of Gastroenterology and Medicine at Mardan Medical Complex Mardan from August 2022 to January 2023. The sample size consisted of 250 adult patients with T2DM, who were sampled consecutively, and who had GI symptoms measured using an adapted version of the Diabetes Bowel Symptom questionnaire. The glycated hemoglobin (HbA1c) <7% was considered as controlled and HbA1c ≥7% as uncontrolled. The following statistical methods were utilized: chisquare, Mann-Whitney U, Spearman correlation and logistic regression.

Results: Mean age was 53.7 ± 10.0 years, 58.0% were female, mean diabetes duration was 6.9 ± 4.2 years and mean HbA1c was 8.1 ± 1.6%; 74.0% had uncontrolled diabetes. GI symptoms were present in 148 (59.2%): dyspepsia 23.2%, bloating 18.8%, diarrhea 15.2% and constipation 14.8%. Of all the symptoms, any one was more common in those with uncontrolled diabetes but not significantly (62.2% vs 50.8%, p = 0.108). HbA1c was higher with dyspepsia (8.6% vs 7.9%, p = 0.027) and correlated weakly with symptom count (rho = 0.15, p = 0.017). Bloating rose with duration, from 12.5% at <5 years to 31.4% at >10 years (p = 0.022). Each 1% rise in HbA1c increased the adjusted odds of any GI symptom (OR 1.21, 95% CI 1.03-1.44, p = 0.023).

Conclusions: GI symptoms were found in people with T2DM. The higher the HbA1c, the higher the rate of dyspepsia and overall symptom burden, and the longer the duration, the more frequent bloating, but they were not significantly divided by the 7% cut-off. They require periodic follow-up.

Keywords: Diabetes Mellitus, Type 2; Glycated Hemoglobin; Gastrointestinal Diseases; Constipation; Diarrhea; Dyspepsia