Onset and disappearance of gastrointestinal symptoms in diabetes: Influence of psychosocial factors, disease duration and glycemic control

Abstract

Although there is anecdotal evidence that gastrointestinal (GI) symptoms in patients with diabetes not infrequently remit and relapse, no studies have evaluated whether symptom turnover occurs in diabetes mellltus (DM). Moreover, predictors of symptom turnover are undefined. We aimed to determine whether glycemic control or psychological factors predicted symptom status change in DM. Methods : A total of 547 DM subjects from the community (70 type 1 and 467 type 2 diabetics) were followed prospectively over 12 months. Subjects completed validated questionnaires. Self-reported glycemic control as well as hemoglobin Alc levels were measured. Glycemic control was classified as poor, fair or good. Results : Chronic constipation (n = 207) and gastroesophageal reflux (GERD) (n = 105) were the most prevalent symptom groups. Amongst the study population, 15% had disappearance and 13% had symptom onset of constipation, while 62% remained free of constipation and 11% were persistently constipated over the follow-up. Similarly, 6% had disappearance and 7% onset of GERD, while 6% remained persistently affected. Adjusting for age and gender, higher levels of depression and a longer duration of diabetes were associated with persistent symptoms of constipation, while low levels of neuroticism and high physical functioning were associated with less likelihood of persistent constipation (table). Similar predictors were found for GERD, except high levels of neuroticism were associated with a higher likelihood of persistent GERD. Glycemic control was not a significant predictor. Conclusions : Psychosocial factors and the duration of diabetes predict persistence of common GI symptoms in DM, but symptom turnover appears independent of changes in glycemic control.