Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors

Table 1 Characteristics of 4738 participants n (%)

	All	Diabetes	Non-diabetes	P value
	(n = 4738)	(n = 603)	(n = 4135)
Age (yr)	60.0 ± 14.3	65.0 ± 11.9	59.3 ± 14.5	< 0.001
Age ≥ 65 (yr)	2102 (44.4)	345 (57.2)	1757 (42.5)	< 0.001
Male sex	2988 (63.1)	472 (78.3)	2516 (60.9)	< 0.001
Height 1	163.3 ± 9.2	165.3 ± 8.7	162.9 ± 9.3	< 0.001
Weight 2	61.1 ± 12.3	65.8 ± 12.7	60.3 ± 12.0	< 0.001
2BMI, kg/m2	22.8 ± 3.5	24.0 ± 3.9	22.6 ± 3.4	< 0.001
Lifestyle factors
Current smoker	2297 (48.5)	337 (55.9)	1960 (47.4)	< 0.001
Current alcohol consumption	2735 (57.7)	322 (53.4)	2413 (58.4)	0.021
Chronic disease
Hypertension	1520 (31.9)	338 (56.1)	1172 (28.3)	< 0.001
Dyslipidemia	802 (16.9)	169 (28.0)	633 (15.3)	< 0.001
Cerebro- cardiovascular disease	435 (9.2)	106 (17.6)	329 (8.0)	< 0.001
Chronic kidney disease	160 (3.4)	56 (9.3)	104 (2.5)	< 0.001
Liver cirrhosis	318 (6.7)	42 (7.0)	276 (6.7)	0.790
Familial history of colorectal cancer	351 (7.4)	43 (7.1)	308 (7.5)	0.781
Medication
NSAIDs	407 (8.6)	53 (8.8)	354 (8.6)	0.852
Low-dose aspirin	445 (9.4)	111 (18.4)	334 (8.1)	< 0.001
Thienopyridine	130 (2.7)	40 (6.6)	90 (2.2)	< 0.001
Dipyridamole	40 (0.84)	4 (0.7)	36 (0.9)	0.603
Cilostazol	55 (1.2)	19 (3.2)	36 (0.9)	< 0.001
Anticoagulants	231 (4.9)	40 (6.6)	191 (4.6)	0.032
Cecum intubation rate	3484 (97.1)	592 (98.2)	4042 (97.8)	0.506
Colorectal disease on colonoscopy with pathology
Colorectal cancer	80 (1.7)	16 (2.7)	64 (1.6)	0.049
Post-colectomy for colorectal cancer	227 (4.8)	40 (6.6)	187 (4.5)	0.023
Other colorectal tumor3	62 (1.3)	8 (1.3)	54 (1.3)	0.967
Inflammatory bowel disease	246 (5.2)	19 (3.2)	227 (5.5)	0.016
Ischemic colitis	50 (1.1)	3 (0.5)	47 (1.1)	0.151
Other colitis	50 (1.1)	3 (0.5)	47 (1.1)	0.151

¹Height was measured in 2834 patients (432 diabetics and 2402 non-diabetics);

²Weight was measured in 2833 patients (431 diabetics and 2402 non-diabetics);

³Other colorectal malignancies included lymphoma, sarcoma, and lipoma. Data presented as number (%). Values presented with plus/minus signs indicate means ± SD. P value is for the comparison between diabetics and non-diabetics. BMI: Body mass index; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 2 Associations between diabetes and bowel symptoms (n = 4738)

GI symptom	Crude OR	P value	Adjusted OR	P value	Adjusted OR	P value
			Model 11		Model 22
Borborygmus	0.81 (0.68-0.96)	0.02	0.93 (0.78-1.11)	0.43	0.94 (0.78-1.14)	0.53
Abdominal distension	1.00 (0.84-1.19)	0.98	1.10 (0.91-1.30)	0.34	1.04 (0.86-1.26)	0.71
Increased flatus	1.14 (0.97-1.33)	0.11	1.12 (0.96-1.32)	0.15	1.15 (0.97-1.37)	0.10
Constipation	1.47 (1.26-1.73)	< 0.001	1.57 (1.33-1.85)	< 0.001	1.43 (1.20-1.70)	< 0.001
Diarrhea	0.88 (0.75-1.04)	0.13	0.98 (0.83-1.15)	0.77	0.97 (0.81-1.17)	0.77
Loose stools	0.96 (0.82-1.13)	0.66	1.06 (0.90-1.25)	0.50	1.02 (0.86-1.23)	0.79
Hard stools	1.57 (1.34-1.84)	< 0.001	1.56 (1.33-1.84)	< 0.001	1.50 (1.26-1.78)	< 0.001
Fecal urgency	1.13 (0.97-1.33)	0.12	1.16 (0.99-1.37)	0.07	1.20 (1.01-1.43)	0.04
Incomplete evacuation	1.11 (0.96-1.30)	0.17	1.16 (1.00-1.36)	0.06	1.16 (0.98-1.37)	0.08

¹Model 1: Adjusted for age, sex, current smoker, and alcohol consumption;

²Model 2: Adjusted for age, sex, smoking, and alcohol consumption after exclusion of organic disease (n = 4087). The numbers in parentheses represent the 95%CI. GI: Gastrointestinal; OR: Odds ratio.

Table 3 Test-retest reliability of bowel symptom score between 1^st and 2^nd questionnaire

Bowel symptoms	All (n = 1197)			Diabetes (n = 152)			Non-Diabetes (n = 1045)
	Kappa value	SE	P value	Kappa value	SE	P value	Kappa value	SE	P value
Borborygmus	0.67	0.02	< 0.001	0.69	0.05	< 0.001	0.67	0.02	< 0.001
Abdominal distension	0.68	0.02	< 0.001	0.71	0.05	< 0.001	0.68	0.02	< 0.001
Increased flatus	0.67	0.02	< 0.001	0.67	0.04	< 0.001	0.67	0.02	< 0.001
Constipation	0.70	0.02	< 0.001	0.71	0.04	< 0.001	0.70	0.02	< 0.001
Diarrhea	0.70	0.02	< 0.001	0.73	0.05	< 0.001	0.69	0.02	< 0.001
Loose stools	0.70	0.02	< 0.001	0.77	0.05	< 0.001	0.70	0.02	< 0.001
Hard stools	0.68	0.02	< 0.001	0.75	0.04	< 0.001	0.67	0.02	< 0.001
Fecal urgency	0.69	0.02	< 0.001	0.69	0.04	< 0.001	0.69	0.02	< 0.001
Incomplete evacuation	0.68	0.02	< 0.001	0.73	0.04	< 0.001	0.67	0.02	< 0.001

GI: Gastrointestinal.

Table 4 Associations between diabetes-related factors and the bowel symptoms in patients with diabetes (n = 241)

	Number of patients (%) or mean ± SD	Crude OR	P value	Adjusted OR (Model 1)1	P value	Adjusted OR (Model 2)2	P value
Constipation
HbA1c ≥ 8.0% (64 mmol/mol)	54/241 (22.4)	2.11 (1.22-3.64)	< 0.01	2.10 (1.21-3.66)	< 0.01	2.11 (1.19-3.73)	0.01
Duration of diabetes (yr)	13.0 ± 8.9	1.02 (0.99-1.04)	0.22	1.02 (1.00-1.05)	0.10	1.02 (0.99-1.05)	0.22
BMI < 25 kg/m²	137/230 (59.6)	1.62 (0.99-2.64)	0.06	1.76 (1.06-2.93)	0.03	2.11 (1.22-3.66)	< 0.01
Cerebro-cardio vascular disease	37/241 (15.3)	1.51 (0.82-2.80)	0.19	1.38 (0.73-2.62)	0.33	1.13 (0.56-2.27)	0.73
Creatinine (μmol/L)	109.6 ± 149.4	0.97 (0.81-1.21)	0.71	0.97 (0.81-1.16)	0.74	1.02 (0.84-1.23)	0.87
Urine protein positive	51/224 (22.8)	0.95 (0.53-1.70)	0.85	0.89 (0.49-1.61)	0.70	0.83 (0.44-1.58)	0.57
Hypoglycemic agents
Insulin	69/241 (28.6)	1.83 (1.11-3.03)	0.02	1.82 (1.07-3.09)	0.03	1.90 (1.08-3.36)	0.03
Sulfonylurea	75/241 (31.1)	0.77 (0.46-1.29)	0.32	0.79 (0.46-1.34)	0.38	0.72 (0.41-1.26)	0.25
Glinide	21/241 (8.7)	1.52 (0.66-3.48)	0.32	1.72 (0.75-3.95)	0.20	2.00 (0.83-4.82)	0.12
Alpha-glucosidase inhibitors	68/241 (28.2)	1.01 (0.60-1.68)	0.98	1.04 (0.62-1.76)	0.88	0.99 (0.58-1.71)	0.98
Biguanide	104/241 (43.1)	1.24 (0.78-1.99)	0.36	1.32 (0.81-2.13)	0.26	1.38 (0.82-2.30)	0.22
Thiazolidine	28/241 (11.6)	0.88 (0.41-1.86)	0.73	0.86 (0.40-1.84)	0.69	0.87 (0.40-1.92)	0.74
DPP-4 inhibitors	36/241 (14.9)	0.73 (0.38-1.39)	0.33	0.77 (0.40-1.49)	0.44	0.83 (0.42-1.62)	0.58
Hard stool
HbA1c ≥ 8.0% (64 mmol/mol)	54/241 (22.4)	1.72 (0.99-2.98)	0.05	1.75 (1.00-3.03)	< 0.05	1.71 (0.97-3.02)	0.06
Duration of diabetes (yr)	13.0 (± 8.9)	1.02 (1.00-1.05)	0.08	1.03 (1.00-1.06)	0.07	1.03 (1.00-1.07)	0.04
BMI < 25 kg/m²	137/230 (59.6)	1.24 (0.76-2.01)	0.39	1.28 (0.78-2.11)	0.33	1.44 (0.85-2.45)	0.17
Cerebro-cardio vascular disease	37/241 (15.3)	1.28 (0.68-2.40)	0.44	1.15 (0.60-2.21)	0.67	1.31 (0.65-2.65)	0.45
Creatinine (μmol/L)	109.6 ± 149.4	1.08 (0.94-1.23)	0.28	1.09 (0.95-1.25)	0.22	1.12 (0.97-1.30)	0.12
Urine protein positive	51/224 (22.8)	1.08 (0.60-1.93)	0.80	1.04 (0.57-1.87)	0.91	1.07 (0.57-2.03)	0.83
Hypoglycemic agents
Insulin	69/241 (28.6)	1.08 (0.65-1.81)	0.76	1.10 (0.65-1.88)	0.72	1.08 (0.61-1.90)	0.79
Sulfonylurea	75/241 (31.1)	0.65 (0.39-1.08)	0.10	0.63 (0.37-1.06)	0.08	0.65 (0.38-1.13)	0.13
Glinide	21/241 (8.7)	1.94 (0.83-4.51)	0.13	2.07 (0.88-4.89)	0.10	2.20 (0.90-5.39)	0.08
Alpha-glucosidase inhibitors	68/241 (28.2)	1.16 (0.69-1.93)	0.57	1.19 (0.70-2.01)	0.52	1.08 (0.63-1.86)	0.78
Biguanide	104/241 (43.1)	1.01 (0.63-1.61)	0.98	1.05 (0.65-1.70)	0.83	0.97 (0.59-1.62)	0.92
Thiazolidine	28/241 (11.6)	0.84 (0.39-1.80)	0.65	0.81 (0.38-1.75)	0.59	0.76 (0.35-1.66)	0.49
DPP-4 inhibitors	36/241 (14.9)	0.69 (0.35-1.33)	0.27	0.70 (0.36-1.37)	0.29	0.75 (0.38-1.47)	0.40
Fecal urgency
HbA1c ≥ 8.0% (64 mmol/mol)	54/241 (22.4)	0.99 (0.56-1.74)	0.97	0.94 (0.53-1.67)	0.83	0.96 (0.53-1.72)	0.88
Duration of diabetes (yr)	13.0 ± 8.9	1.01 (0.98-1.03)	0.65	1.00 (0.98-1.03)	0.76	1.01 (0.98-1.04)	0.56
BMI < 25 kg/m²	137/230 (59.6)	1.62 (0.98-2.67)	0.06	1.81 (1.08-3.03)	0.03	1.73 (1.00-2.98)	< 0.05
Cerebro-cardio vascular disease	37/241 (15.3)	1.41 (0.73-2.71)	0.31	1.41 (0.72-2.78)	0.32	1.74 (0.84-3.59)	0.14
Creatinine (μmol/L)	109.6 (± 149.4)	1.16 (0.98-1.39)	0.09	1.15 (0.97-1.36)	0.12	1.14 (0.94-1.39)	0.18
Urine protein positive	51/224 (22.8)	0.72 (0.39-1.33)	0.29	0.70 (0.38-1.29)	0.25	0.78 (0.40-1.51)	0.45
Hypoglycemic agents
Insulin	69/241 (28.6)	1.59 (0.95-2.66)	0.08	1.65 (0.96-2.83)	0.07	1.67 (0.94-2.95)	0.08
Sulfonylurea	75/241 (31.1)	0.56 (0.33-0.93)	0.03	0.57 (0.33-0.96)	0.03	0.61 (0.35-1.07)	0.08
Glinide	21/241 (8.7)	1.29 (0.57-2.91)	0.55	1.38 (0.60-3.16)	0.45	1.43 (0.59-3.44)	0.42
Alpha-glucosidase inhibitors	68/241 (28.2)	1.17 (0.70-1.96)	0.54	1.18 (0.70-1.98)	0.53	1.22 (0.71-2.08)	0.47
Biguanide	104/241 (43.1)	1.55 (0.97-2.48)	0.07	1.63 (1.01-2.63)	< 0.05	1.65 (0.99-2.73)	0.05
Thiazolidine	28/241 (11.6)	0.77 (0.52-2.12)	0.90	1.08 (0.53-2.21)	0.83	1.23 (0.60-2.54)	0.58
DPP-4 inhibitors	36/241 (14.9)	0.64 (0.33-1.26)	0.20	0.64 (0.32-1.30)	0.20	0.67 (0.34-1.34)	0.26
Incomplete evacuation
HbA1c ≥ 8.0% (64 mmol/mol)	54/241 (22.4)	1.49 (0.85-2.60)	0.16	1.50 (0.86-2.64)	0.15	1.49 (0.84-2.64)	0.18
Duration of diabetes (yr)	13.0 ± 8.9	1.02 (1.00-1.05)	0.08	1.02 (1.00-1.06)	0.07	1.03 (1.00-1.06)	0.08
BMI < 25 kg/m²	137/230 (59.6)	2.09 (1.29-3.40)	< 0.01	2.21 (1.34-3.65)	< 0.01	2.60 (1.52-4.43)	< 0.01
Cerebro-cardio vascular disease	37/241 (15.3)	1.67 (0.89-3.12)	0.11	1.61 (0.84-3.07)	0.15	1.81 (0.90-3.61)	0.09
Creatinine (μmol/L)	109.6 ± 149.4	1.24 (1.08-1.42)	< 0.01	1.25 (1.09-1.43)	< 0.01	1.27 (1.10-1.47)	< 0.01
Urine protein positive	51/224 (22.8)	1.41 (0.80-2.48)	0.24	1.38 (0.78-2.45)	0.27	1.45 (0.79-2.69)	0.23
Hypoglycemic agents
Insulin	69/241 (28.6)	1.65 (0.99-2.76)	0.05	1.77 (1.03-3.02)	0.04	1.92 (1.09-3.38)	0.02
Sulfonylurea	75/241 (31.1)	0.85 (0.52-1.40)	0.53	0.83 (0.50-1.38)	0.47	0.89 (0.52-1.52)	0.68
Glinide	21/241 (8.7)	2.27 (1.00-5.18)	0.05	2.39 (1.03-5.52)	0.04	2.33 (0.95-5.73)	0.06
Alpha-glucosidase inhibitors	68/241 (28.2)	0.92 (0.55-1.52)	0.74	0.92 (0.55-1.54)	0.76	0.85 (0.50-1.44)	0.55
Biguanide	104/241 (43.1)	1.19 (0.76-1.89)	0.44	1.22 (0.77-1.94)	0.40	1.15 (0.70-1.87)	0.58
Thiazolidine	28/241 (11.6)	1.07 (0.52-2.25)	0.84	1.07 (0.51-2.24)	0.86	1.14 (0.53-2.42)	0.74
DPP-4 inhibitors	36/241 (14.9)	0.49 (0.26-0.94)	0.03	0.49 (0.25-0.94)	0.03	0.52 (0.27-1.01)	0.05

¹Model 1: Adjusted for age, sex, smoking, and alcohol consumption;

²Model 2: Adjusted for age, sex, smoking, and alcohol consumption after exclusion of organic disease (n = 201). The numbers in parentheses represent the 95% confidence interval. BMI: Body mass index; DPP-4: Dipeptidyl peptidase-4; HbA1c: Glycated hemoglobin; OR: Odds ratio.