Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Division of Endocrinology and Metabolism, St. Joseph's Health Care, Western University, London, Canada.
J Clin Endocrinol Metab. 2022 May 17;107(6):e2431-e2437. doi: 10.1210/clinem/dgac093.
To assess reported rates of gastrointestinal (GI) symptoms and their association with autoimmune diseases and microvascular complications in adults and children with type 1 diabetes.
The Gastrointestinal Symptom Scale was used to assess GI symptom type and severity in 2370 patients with type 1 diabetes aged 8 to 45 years evaluated as part of a clinical trial screening for celiac disease (CD). The presence and severity of GI symptoms and relationships with demographic, clinical, and other diabetes-related factors were evaluated.
Overall, 1368 adults (57.7%) aged 19 to 45 years and 1002 (42.3%) pediatric patients aged 8 to 18 years were studied. At least 1 GI symptom was reported in 34.1% of adults as compared with 21.7% of children (P < 0.0001). Common symptoms in children included upper and lower abdominal pain while adults more frequently reported lower GI symptoms. Participants with GI symptoms had higher hemoglobin A1c (HbA1c) levels (68 ± 14mmol/mol; 8.35 ± 1.37%) than those without symptoms (66 ± 15mmol/mol; 8.22 ± 1.40%; P = 0.041). Patients with microvascular complications (nephropathy, retinopathy, and/or neuropathy) were 1.8 times more likely to report GI symptoms (95% CI: 1.26-2.60; P < 0.01) after adjusting for age and sex. No association was observed between GI symptoms and the presence of autoimmune conditions, including thyroid and biopsy-confirmed CD (odds ratio = 1.1; 95% CI: 0.86-1.42; P = 0.45).
These results highlight that GI symptoms are an important clinical morbidity and are associated with increasing age, duration of type 1 diabetes, HbA1c, and microvascular complications but not with autoimmune comorbidities including CD.
评估胃肠道（GI）症状的报告发生率及其与 1 型糖尿病成人和儿童的自身免疫性疾病和微血管并发症的关系。
使用胃肠道症状量表评估了 2370 名年龄在 8 至 45 岁之间的 1 型糖尿病患者的胃肠道症状类型和严重程度，这些患者是作为乳糜泻（CD）临床试验筛查的一部分进行评估的。评估了胃肠道症状的存在和严重程度及其与人口统计学、临床和其他糖尿病相关因素的关系。
总体而言，研究了 19 至 45 岁的 1368 名成年人（57.7%）和 8 至 18 岁的 1002 名儿科患者（42.3%）。与儿童（21.7%）相比，至少有一种胃肠道症状的成年人占 34.1%（P<0.0001）。儿童常见的症状包括上腹痛和下腹痛，而成年人则更常报告下胃肠道症状。有胃肠道症状的参与者的血红蛋白 A1c（HbA1c）水平（68±14mmol/mol；8.35±1.37%）高于无症状参与者（66±15mmol/mol；8.22±1.40%；P=0.041）。微血管并发症（肾病、视网膜病变和/或神经病变）患者报告胃肠道症状的可能性是无胃肠道症状患者的 1.8 倍（95%CI：1.26-2.60；P<0.01），校正年龄和性别后。在调整了年龄和性别后，胃肠道症状与包括甲状腺和活检证实的 CD 在内的自身免疫性疾病的存在之间没有关联（比值比=1.1；95%CI：0.86-1.42；P=0.45）。
这些结果强调了胃肠道症状是一种重要的临床疾病，与年龄增长、1 型糖尿病病程、HbA1c 和微血管并发症相关，但与包括 CD 在内的自身免疫性合并症无关。
