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World J Gastroenterol. Apr 7, 2014; 20(13): 3507-3515
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3507
Glucose intolerance and diabetes mellitus in ulcerative colitis: Pathogenetic and therapeutic implications
Giovanni Maconi, Federica Furfaro, Roberta Sciurti, Cristina Bezzio, Sandro Ardizzone, Roberto de Franchis
Giovanni Maconi, Federica Furfaro, Roberta Sciurti, Cristina Bezzio, Sandro Ardizzone, Roberto de Franchis, Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, 20157 Milano, Italy
Author contributions: Maconi G contributed to conception and design, literature search, manuscript preparation and editing; Furfaro F and Sciurti R literature search, manuscript preparation and editing; Bezzio C, Ardizzone S and de Franchis R contributed to critical revision and editing; all authors gave the final approval of the version; Maconi G is the guarantor of the article.
Correspondence to: Giovanni Maconi, MD, Professor, Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, Via G.B. Grassi, 74, 20157 Milano, Italy. giovanni.maconi@unimi.it
Telephone: +39-02-39043164
Received: October 20, 2013
Revised: January 26, 2014
Accepted: March 6, 2014
Published online: April 7, 2014
Abstract

Diabetes mellitus is one of the most frequent co-morbidities of ulcerative colitis patients. The epidemiological association of these diseases suggested a genetic sharing and has challenged gene identification. Diabetes co-morbidity in ulcerative colitis has also relevant clinical and therapeutic implications, with potential clinical impact on the follow up and outcome of patients. These diseases share specific complications, such as neuropathy, hepatic steatosis, osteoporosis and venous thrombosis. It is still unknown whether the coexistence of these diseases may increase their occurrence. Diabetes and hyperglycaemia represent relevant risk factors for postoperative complications and pouch failure in ulcerative colitis. Medical treatment of ulcerative colitis in patients with diabetes mellitus may be particularly challenging. Corticosteroids are the treatment of choice of active ulcerative colitis. Their use may be associated with the onset of glucose intolerance and diabetes, with difficult control of glucose levels and with complications in diabetic patients. Epidemiologic and genetic evidences about diabetes co-morbidity in ulcerative colitis patients and shared complications and treatment of patients with these diseases have been discussed in the present review.

Keywords: Diabetes mellitus, Ulcerative colitis, Diabetes complications, Inflammatory bowel diseases, Glucose intolerance, Medical therapy, Corticosteroids

Core tip: The relationship between ulcerative colitis and diabetes mellitus is intriguing, full of practical and speculative information, useful for clinical practice and basic research. Diabetes mellitus is one of the most frequent co-morbidities of ulcerative colitis and their epidemiological association suggests genetic sharing and stimulates studies for gene identification. Diabetes also shares specific complications with ulcerative colitis and represents a challenging condition in ulcerative colitis patients for the treatment of the disease, due to difficult control of glucose levels and for high risk of postoperative complications and pouch failure. All these issues have been discussed in the present review.