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Chronic constipation and chronic diarrhea in patients with diabetes mellitus


Diabetic individuals commonly report disordered bowel habits. The aim of a study was to report the prevalence and associated factors of chronic diarrhea and chronic constipation in diabetics using a nationally representative sample of US adults.

Analyses were performed using data from subjects in the 2009–2010 National Health and Nutrition Examination Survey ( NHANES ) dataset who completed the Bowel Health Questionnaire.
The NHANES dataset provides medical comorbidities, demographics, and dietary habits of a nationally representative group of adult survey participants in the United States.

Chronic constipation and chronic diarrhea were defined by Bristol Stool Form Scale ( BSFS ) Types 1 & 2 and BSFS Types 6 & 7 as the usual or most common stool type, respectively, and frequent laxative users were also defined as having chronic constipation.

Researchers have identified 661 diabetic subjects and 4488 non-diabetic subjects. Diabetic subjects ( 25.8% ) reported disordered bowel habits.

In unadjusted analysis, chronic diarrhea was more prevalent in diabetics than in non-diabetics ( 11.2% vs. 6.0%; p  less than 0.0001 ); however, the prevalence of chronic constipation was not significantly different between groups ( 14.6% vs. 11.2%; p = 0.126 ).

When adjusting for covariates ( e.g., BMI [ Body Mass Index ], gender, age, race / ethnicity, education level, etc. ), diabetes itself remained associated with chronic diarrhea.
Diabetic individuals with chronic diarrhea more frequently used drugs to lower blood sugar, and diabetic subjects with chronic constipation more frequently had poor kidney function.

In conclusion, chronic diarrhea is significantly more prevalent in diabetics than in non-diabetics, whereas chronic constipation is not, and the association between chronic diarrhea and diabetes remains significant when adjusting for covariates.
Use of medications that lower blood sugar is associated with chronic diarrhea in diabetic individuals, whereas poor kidney function is associated with chronic constipation in diabetics. ( Xagena )

Sommers T et al, Am J Gastroenterol 2018; Epub ahead of print

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