Leeds John S, Hadjivassiliou Marios, Tesfaye Solomon, Sanders David S
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK.
BMJ Open Diabetes Res Care. 2018 May 29;6(1):e000514. doi: 10.1136/bmjdrc-2018-000514. eCollection 2018.
Lower gastrointestinal symptoms are not well characterized in people with type 1 diabetes, and the effects on quality of life and glycemic control are unknown. This study aimed to determine the prevalence of lower gastrointestinal symptoms and the effects on glycemic control and quality of life, and to investigate for underlying causes.
This is a prospective, cohort study in secondary care. Patients with type 1 diabetes completed a gastrointestinal symptom questionnaire and the Short Form 36 V.2 quality of life questionnaire and had their hemoglobin A1c measured. Patients with diarrhea were offered reassessment and investigation as per the national guidelines. Controls without diabetes were used to compare symptom prevalence and quality of life scores.
706 with type 1 diabetes (mean age 41.9 years) and 604 controls (mean age 41.9 years) were enrolled. Gastrointestinal symptoms were significantly more frequent in type 1 diabetes compared with controls, in particular constipation (OR 2.4), diarrhea (OR 2.5), alternating bowel habit (OR 2.1), abdominal pain (OR 1.4), floating stools (OR 2.7), bloating (OR 1.4) and flatulence (OR 1.3) (all p<0.05). Previous pancreatitis was more frequent in type 1 diabetes (OR 4.6), but other gastrointestinal conditions were not. Gastrointestinal symptoms were associated with poorer glycemic control (p<0.01) and worse quality of life particularly in those with diarrhea. Investigation of those with diarrhea, including those with alternating bowel habit, (n=105), identified a cause in 72.3% with subsequent change in management.
Gastrointestinal symptoms are twice as common in type 1 diabetes and associated with poorer quality of life and glycemic control. Investigation of diarrhea in people with type 1 diabetes leads to a high yield of treatable conditions and a change in management in about three-quarters.
1型糖尿病患者的下消化道症状特征尚不明确，其对生活质量和血糖控制的影响也未知。本研究旨在确定下消化道症状的患病率及其对血糖控制和生活质量的影响，并探究潜在病因。
这是一项在二级医疗保健机构进行的前瞻性队列研究。1型糖尿病患者完成了一份胃肠道症状问卷和简短健康调查简表36 V.2生活质量问卷，并检测了糖化血红蛋白。腹泻患者按照国家指南接受重新评估和检查。选取无糖尿病的对照组来比较症状患病率和生活质量评分。
共纳入706例1型糖尿病患者（平均年龄41.9岁）和604例对照组（平均年龄41.9岁）。与对照组相比，1型糖尿病患者的胃肠道症状明显更常见，尤其是便秘（比值比2.4）、腹泻（比值比2.5）、排便习惯改变（比值比2.1）、腹痛（比值比1.4）、大便漂浮（比值比2.7）、腹胀（比值比1.4）和气胀（比值比1.3）（均p<0.05）。既往胰腺炎在1型糖尿病患者中更常见（比值比4.6），但其他胃肠道疾病并非如此。胃肠道症状与血糖控制较差（p<0.01）和生活质量较差相关，尤其是腹泻患者。对腹泻患者（包括排便习惯改变者）（n = 105）进行检查后发现，72.3%的患者有病因，随后管理方式发生了改变。
胃肠道症状在1型糖尿病患者中的发生率是正常人的两倍，且与较差的生活质量和血糖控制相关。对患有1型糖尿病的腹泻患者进行检查可发现大量可治疗的疾病，约四分之三的患者管理方式会发生改变。
