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

Abstract

AIM:

To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.

METHODS:

Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.

RESULTS:

In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P < 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P < 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c ≥ 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) < 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI < 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI < 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).

CONCLUSION:

Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.

• Authors: Noriko Ihana-Sugiyama, Naoyoshi Nagata, Ritsuko Yamamoto-Honda, Eiko Izawa, Hiroshi Kajio, Takuro Shimbo, Masafumi Kakei, Naomi Uemura, Junichi Akiyama, Mitsuhiko Noda
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 22 Issue 11 Pg. 3252-60 (Mar 21 2016) ISSN: 2219-2840 [Electronic] United States
• PMID: 27004003 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Case-Control Studies
• Chi-Square Distribution
• Colonoscopy
• Constipation (diagnosis, etiology, physiopathology)
• Cross-Sectional Studies
• Defecation
• Diabetes Complications (diagnosis, etiology, physiopathology)
• Diarrhea (diagnosis, etiology, physiopathology)
• Feces (chemistry)
• Female
• Hardness
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Prospective Studies
• Risk Factors
• Surveys and Questionnaires