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PTH-075 Is there a need for combined gastrointestinal and diabetes clinics? A prospective study of the prevalence of diarrhoea in patients with type 1 diabetes mellitus and findings on investigation
  1. J S Leeds1,
  2. A D Hopper1,
  3. S Tesfaye2,
  4. M Hadjivassiliou3,
  5. D S Sanders1
  1. 1Gastroenterology and Liver Unit, Royal Halamshire Hospital, Sheffield, UK
  2. 2Department of Diabetes, Royal Halamshire Hospital, Sheffield, UK
  3. 3Department of Neurology, Royal Halamshire Hospital, Sheffield, UK


Introduction The relationship between diabetes mellitus and the gastrointestinal tract (GI) has been described however symptoms are often missed. GI symptoms are often ascribed to autonomic neuropathy and no further investigations are instigated. The prevalence of potentially treatable GI conditions in patients with Type 1 diabetes and diarrhoea is unknown. We therefore assessed a group of patients with Type 1 diabetes and diarrhoea to determine the role of gastroenterology input.

Methods Patients with Type 1 diabetes mellitus were recruited and asked to complete a previously validated GI symptom questionnaire and Short Form 36 version 2 quality of life questionnaire. Patients who described diarrhoea were offered reassessment in a gastroenterology clinic. All patients were investigated as per BSG guidelines for the management of chronic diarrhoea and were tested for coeliac disease (serology and duodenal biopsy), thyroid dysfunction, small bowel bacterial overgrowth (glucose hydrogen breath test), pancreatic disease (faecal elastase-1 and imaging), colonic disease (colonoscopy), bile acid malabsorption (SeHCAT scan) and autonomic neuropathy (cardiac autonomic function tests).

Results 1000 patients with Type 1 diabetes mellitus (mean age 42.2 years) were initially recruited of which 94 (9.4%, 7.7–11.4) had diarrhoea. These individuals had significantly worse glycaemic control (p=0.008) and quality of life scores (all p<0.001) compared to age and sex matched controls with Type 1 diabetes alone. Following investigation 34/94 (36.2%, 26.5–46.7) met the Rome II criteria for IBS and were treated with antispasmodics and/or low dose antidepressants. 14/94 (14.9%, 8.4–23.7) had autonomic neuropathy (5 also had small bowel bacterial overgrowth and improved with antibiotics). 14/94 had positive coeliac serology of which nine had villous atrophy on biopsy (9.6%, 4.5–17.4) and started a gluten free diet. 10/94 (10.6%, 5.2–18.7) had inflammatory bowel disease (7 UC, 2 Crohn's disease and 1 microscopic colitis) and were started on treatment. Six individuals had exocrine pancreatic disease (2 with chronic pancreatitis on CT scan) all improved on enzyme supplements. Other diagnoses included lactose intolerance, IgA deficiency, diverticular disease, peritoneal dialysis related and rectal cancer. 11 patients (11.7%) couldn't be classified. In 68/94 (72.3%) there was a change in management.

Conclusion Gi symptoms are common in patients with Type 1 diabetes and is associated with worse glycaemic control and quality of life. Investigation leads to a high yield of treatable conditions and a change in management of about three quarters. GI symptoms should be assessed in diabetes clinics.

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