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Gastrointestinal Tract Symptoms Among Persons With Diabetes Mellitus in the Community
Dordaneh Maleki, MD;
G. Richard Locke III, MD;
Michael Camilleri, MD;
Alan R. Zinsmeister, PhD;
Barbara P. Yawn, MD;
Cynthia Leibson, PhD;
L. Joseph Melton III, MD
Arch Intern Med. 2000;160:2808-2816.
Background Gastrointestinal (GI) tract symptoms are common among patients with diabetes mellitus (DM) seen in tertiary care centers. The degree to which this reflects referral bias is unclear.
Objectives To determine whether GI tract symptoms are more prevalent in unselected patients with DM from the general community compared with their age- and sex-matched counterparts without DM and to assess the association of GI tract symptoms in persons with DM with psychosomatic symptoms, medication use, and symptoms of autonomic neuropathy.
Methods In this population-based, cross-sectional study, Olmsted County, Minnesota, residents with type 1 DM, a random sample of residents with type 2 DM, and 2 age- and sex-stratified random samples of nondiabetic residents (total of 1262 person for the 4 groups) were mailed a previously validated symptom questionnaire.
Results Heartburn was less common in residents with type 1 DM vs controls (12% vs 23%; P<.05). No significant difference in prevalence was detected (residents with type 1 DM vs controls; residents with type 2 DM vs controls) for nausea or vomiting (12% vs 11%; 6% vs 6%), dyspepsia (19% vs 21%; 13% vs 17%), or constipation (17% vs 14%; 10% vs 12%). However, constipation and/or laxative use was slightly more common in residents with type 1 DM (27% vs 19%; P<.15), particularly in men, and was associated with the intake of calcium channel blockers.
Conclusions In the community, the prevalence of most GI tract symptoms is similar in persons with or without DM, except for a lower prevalence of heartburn and an increased prevalence of constipation or laxative use in residents with type 1 DM, especially in men. This difference is associated with calcium channel blocker use rather than symptoms of autonomic neuropathy. In community-based practices, physicians should not immediately assume that GI tract symptoms in patients with DM represent a complication of DM.
From the Gastroenterology Research Unit (Drs Maleki, Locke, and Camilleri) and the Department of Health Sciences Research, Mayo Clinic (Drs Locke, Zinsmeister, Leibson, and Melton),and Olmsted Medical Center (Dr Yawn), Rochester, Minn. Dr Maleki is now with the Department of Gastroenterology, Allegheny University Hospitals, Philadelphia, Pa. Dr Locke is a recipient of grants to perform patient-based research from Glaxo Wellcome Inc, Research Triangle Park, NC; SmithKline Beecham Pharmaceuticals, Collegeville, Pa; and AstraZeneca Pharmaceuticals, Wayne, Pa. Dr Locke has served as a consultant for Glaxo Wellcome Inc and Novartis Pharmaceuticals, Hanover, NJ. Dr Camilleri is a recipient of grants to perform patient-based research or participated in the development of the clinical research programs of the following pharmaceutical companies: Janssen Pharamceutica, Titusville, NJ; GlaxoWellcome Inc, Research Triangle Park, NC; SmithKline Beecham Pharmaceuticals, Philadelphia, Pa; Sandoz Pharaceuticals Corp (formerly Novartis), Hanover, NJ; Meretek, Nashville, Tenn; TAP Pharmaceuticals, Deerfield, Ill; Abbott Laboratories, North Chicago, Ill; Regeneron, Tarrytown, NY; Sanofi Inc, New York, NY. He also received also received honoraria or consultancy fees for lecturing to the gastrointestinal or neuroscience groups of some of these companies. Dr Camilleri has given visiting lectureships at several hospitals and university medical centers.
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