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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors
Noriko Ihana-Sugiyama, Naoyoshi Nagata, Ritsuko Yamamoto-Honda, Eiko Izawa, Hiroshi Kajio, Takuro Shimbo, Masafumi Kakei, Naomi Uemura, Junichi Akiyama, Mitsuhiko Noda
Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Noriko Ihana-Sugiyama, Masafumi Kakei, Division of General Medicine, Jichi Medical University Graduate School of Medicine, Tochigi 329-0498, Japan
Naoyoshi Nagata, Eiko Izawa, Junichi Akiyama, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Ritsuko Yamamoto-Honda, Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo 105-0001, Japan
Eiko Izawa, Mitsuhiko Noda, Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Takuro Shimbo, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Takuro Shimbo, Ohta Nishinouchi Hospital, Fukushima 963-8022, Japan
Masafumi Kakei, First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine, Saitama 330-0834, Japan
Naomi Uemura, Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba 272-8516, Japan
Mitsuhiko Noda, Department of Endocrinology and Diabetes, Saitama Medical University, Saitama 350-0495, Japan
Author contributions: Ihana-Sugiyama N and Nagata N wrote the manuscript; Nagata N is an equal first author; Nagata N and Noda M designed the study; Ihana-Sugiyama N, Yamamoto-Honda R, Izawa E and Nagata N collected clinical information; Shimbo T advised on statistical analysis; Nagata N and Akiyama J performed endoscopy; Kajio H, Kakei M, Noda M and Uemura N advised on the manuscript content; Nagata N, Akiyama J and Noda M edited the manuscript.
Supported by Health Sciences Research Grants (Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus No. H25-016) from the Ministry of Health, Labour and Welfare of Japan, and supported in part by Grants-in-Aid for Research from the National Center for Global Health and Medicine No. 26A-201.
Institutional review board statement: Ethics approval was obtained from the institutional review board of the National Center for Global Health and Medicine in Tokyo, Japan.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naoyoshi Nagata, MD, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. nnagata_ncgm@yahoo.co.jp
Telephone: +81-3-32027181
Received: November 9, 2015
Peer-review started: November 10, 2015
First decision: November 27, 2015
Revised: December 12, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 21, 2016
AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.
METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.
RESULTS: In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P < 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P < 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c ≥ 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) < 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI < 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI < 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).
CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.
Core tip: This study determined the bowel symptoms associated with diabetes. Patients underwent colonoscopy and completed a questionnaire on 9 bowel symptoms. Symptoms evaluated on a 7-point Likert scale were compared between baseline and the second questionnaire for test-retest reliability. Constipation and hard stools were associated with diabetes, and fecal urgency and incomplete evacuation were marginally associated with diabetes. These relations remained after excluding organic gastrointestinal diseases. Long-term reliability of symptom score suggested that these symptoms remain consistent over a given period. In diabetes, poor glycemic control, diabetes duration, low BMI, and high creatinine level were associated with these symptoms.
