Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus
Midori Fujishiro, Akifumi Kushiyama, Hiroki Yamazaki, Sunao Kaneko, Yuko Koketsu, Takeshi Yamamotoya, Takako Kikuchi, Hideyuki Sakoda, Ryo Suzuki, Takashi Kadowaki
Midori Fujishiro, Hiroki Yamazaki, Sunao Kaneko, Ryo Suzuki, Takashi Kadowaki, Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
Akifumi Kushiyama, Takako Kikuchi, Division of Diabetes and Metabolism, Institute for Adult Diseases, Asahi Life Foundation, Tokyo 103-0002, Japan
Yuko Koketsu, Department of Diabetes and Metabolic Diseases, Shinko Hospital, Kobe 651-0072, Japan
Takeshi Yamamotoya, Department of Medical Science, Graduate School of Medicine, University of Hiroshima, Hiroshima 734-8553, Japan
Hideyuki Sakoda, Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki 889-1692, Japan
Author contributions: Fujishiro M and Kushiyama A contributed equally to this work; Fujishiro M designed the study, collected and analyzed the data, and drafted the manuscript; Kushiyama A provided analytical oversight and revised the manuscript for important intellectual content; Yamazaki H, Kaneko S, Koketsu Y and Yamamotoya T collected and analyzed the data; Kikuchi T analyzed the data; Sakoda H designed the study and collected the data; Suzuki R and Kadowaki T supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the University of Tokyo Hospital Institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Midori Fujishiro, MD, PhD, Assistant Professor, Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. midori-tky@umin.ac.jp
Telephone: +81-3-3815-5411 Fax: +81-3-5802-5679
Received: December 14, 2016
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
AIM
To unravel relationships between gastrointestinal (GI) symptoms impairing quality of life (QOL) and clinical profiles of diabetes mellitus (DM) patients.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
