Rana S V, Malik Aastha, Bhadada Sanjay K, Sachdeva Naresh, Morya Rajesh Kumar, Sharma Gaurav
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India.
Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India.
Indian J Clin Biochem. 2017 Mar;32(1):84-89. doi: 10.1007/s12291-016-0569-6. Epub 2016 May 3.
Type 2 diabetes mellitus consists of dysfunctions characterized by hyperglycemia and resulting from combination of resistance to insulin action and inadequate insulin secretion. Most of diabetic patients report significant gastrointestinal symptoms. Entire GI tract can be affected by diabetes from oral cavity to large bowel and anorectal region. Proteins, carbohydrates, fats, and most fluids are absorbed in small intestine. Malabsorption may occurs when proper absorption of nutrients does not take place due to bacterial overgrowth or altered gut motility. The present study was planned to measure various malabsorption parameters in type 2 diabetic patients. 175 patients and 175 age and sex matched healthy controls attending Endocrinology Clinic in PGI, Chandigarh were enrolled. Lactose intolerance was measured by using non-invasive lactose hydrogen breath test. Urinary d-xylose and fecal fat were estimated using standard methods. Orocecal transit time and small intestinal bacterial overgrowth were measured using non-invasive lactulose and glucose breath test respectively. Out of 175 diabetic patients enrolled, 87 were males while among 175 healthy subjects 88 were males. SIBO was observed in 14.8 % type 2 diabetic patients and in 2.8 % of controls. There was statistically significant increase ( < 0.002) in OCTT in type 2 diabetic patients compared with controls. OCTT was observed to be more delayed ( < 0.003) in patients who were found to have SIBO than in patients without SIBO. Lactose intolerance was observed in 60 % diabetic patients and 39.4 % in controls. Urinary d-xylose levels were also lower in case of diabetic patients but no significant difference was found in 72 h fecal fat excretion among diabetic patients and controls. Urinary d-xylose and lactose intolerance in SIBO positive type 2 diabetic patients was more severe as compared to SIBO negative diabetic patients. From this study we can conclude that delayed OCTT may have led to SIBO which may have instigated the process of malabsorption among type 2 diabetic patients.
2型糖尿病由以高血糖为特征的功能障碍组成，这些功能障碍是胰岛素作用抵抗和胰岛素分泌不足共同作用的结果。大多数糖尿病患者报告有明显的胃肠道症状。从口腔到大肠及肛门直肠区域，整个胃肠道都可能受到糖尿病的影响。蛋白质、碳水化合物、脂肪和大多数液体在小肠中被吸收。当由于细菌过度生长或肠道动力改变导致营养物质不能正常吸收时，可能会发生吸收不良。本研究旨在测量2型糖尿病患者的各种吸收不良参数。纳入了175例患者以及175例年龄和性别相匹配的健康对照者，他们均在昌迪加尔的PGI内分泌诊所就诊。通过非侵入性乳糖氢呼气试验测量乳糖不耐受情况。使用标准方法测定尿d-木糖和粪便脂肪。分别通过非侵入性乳果糖和葡萄糖呼气试验测量口盲肠转运时间和小肠细菌过度生长情况。在纳入的175例糖尿病患者中，87例为男性，而在175例健康受试者中，88例为男性。在2型糖尿病患者中观察到小肠细菌过度生长的比例为14.8%，在对照组中为2.8%。与对照组相比，2型糖尿病患者的口盲肠转运时间有统计学显著增加（<0.002）。发现有小肠细菌过度生长的患者的口盲肠转运时间比没有小肠细菌过度生长的患者延迟更明显（<0.003）。在糖尿病患者中观察到乳糖不耐受的比例为60%，在对照组中为39.4%。糖尿病患者的尿d-木糖水平也较低，但糖尿病患者和对照组之间在72小时粪便脂肪排泄方面未发现显著差异。与小肠细菌过度生长阴性的糖尿病患者相比，小肠细菌过度生长阳性的2型糖尿病患者的尿d-木糖和乳糖不耐受情况更严重。从这项研究我们可以得出结论，口盲肠转运时间延迟可能导致了小肠细菌过度生长，这可能引发了2型糖尿病患者的吸收不良过程。
