Digestive, Anorectal, and Urogenital Functions in Patients with Type 2 Diabetes Mellitus, Impaired Glucose Tolerance and Normal Glucose Tolerance: Association with Autonomic Neuropathy.

IF 1.6 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM
Daniel R Quast, Georgios C Boronikolos, Bjoern A Menge, Thomas Gk Breuer, Nina Schenker, Juris J Meier
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引用次数: 1

Abstract

Aims: Gastrointestinal disorders, including constipation and fecal incontinence, are common in type 2 diabetes mellitus (T2DM) and may derive from diabetic autonomic neuropathy, severe intestinal bacterial overgrowth, or a dysfunctional anorectal sphincter. The present study aims to characterize the correlation between these conditions.

Methods: Patients with T2DM, prediabetes, and normal glucose tolerance (NGT) were included. The anorectal function was assessed with high-resolution anorectal manometry. Patients were screened for autonomic neuropathy by measuring olfactory, sweat, and erectile dysfunction as well as heart rate variability. Constipation and fecal (in-)continence were evaluated using validated questionnaires. Breath tests were used to assess severe intestinal bacterial overgrowth.

Results: We included 59 participants (32 (54.2%) with T2DM, 9 (15.3%) with prediabetes, and 18 (30.5%) NGT). The presence of autonomic neuropathy, severe bacterial overgrowth, and symptoms of constipation and incontinence were comparable. HbA1c was correlated with an increased anorectal resting sphincter pressure (r=0.31, P=0.019) and constipation symptoms (r=0.30, P=0.031). In patients with a long-standing diagnosis of T2DM, significantly higher values for maximum anorectal resting pressure (Δ=+27.81±7.84 mmHg, P=0.0015) and baseline pressure (Δ=20.50±9.74 mmHg, P=0.046) were found compared with NGT, but not with prediabetes.

Conclusions: Long-standing T2DM increases anorectal sphincter activity, and constipation symptoms are associated with higher HbA1c levels. The lack of an association of symptoms with autonomic neuropathy suggests glucotoxicity as the primary mechanism.

2型糖尿病患者的消化、肛肠和泌尿生殖功能,糖耐量受损和糖耐量正常:与自主神经病变的关系
目的:胃肠道疾病,包括便秘和大便失禁,在2型糖尿病(T2DM)中很常见,可能源于糖尿病自主神经病变、严重的肠道细菌过度生长或肛肠括约肌功能障碍。本研究旨在描述这些条件之间的相关性。方法:纳入T2DM、糖尿病前期、正常糖耐量(NGT)患者。采用高分辨率肛肠测压法评估肛肠功能。通过测量嗅觉、汗液、勃起功能障碍以及心率变异性来筛选患者是否有自主神经病变。便秘和大便失禁采用有效问卷进行评估。呼吸试验用于评估严重的肠道细菌过度生长。结果:我们纳入了59名参与者,其中32名(54.2%)患有T2DM, 9名(15.3%)患有糖尿病前期,18名(30.5%)患有NGT。自主神经病变、严重细菌过度生长、便秘和尿失禁的症状具有可比性。HbA1c与肛门直肠静息括约肌压力升高(r=0.31, P=0.019)和便秘症状(r=0.30, P=0.031)相关。在长期诊断为T2DM的患者中,与NGT相比,最大肛门直肠静息压(Δ=+27.81±7.84 mmHg, P=0.0015)和基线压(Δ=20.50±9.74 mmHg, P=0.046)的值明显更高,但与糖尿病前期相比没有明显差异。结论:长期T2DM增加肛肠括约肌活动,便秘症状与较高的HbA1c水平相关。缺乏与自主神经病变症状的关联提示糖毒性是主要机制。
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来源期刊
CiteScore
4.10
自引率
5.60%
发文量
72
审稿时长
3 months
期刊介绍: Publishing outstanding articles from all fields of endocrinology and diabetology, from molecular biology to clinical research, this journal is a brilliant resource. Since being published in English in 1983, the popularity of this journal has grown steadily, reflecting the importance of this publication within its field. Original contributions and short communications appear in each issue along with reviews addressing current topics. In addition, supplementary issues are published each year presenting abstracts or proceedings of national and international scientific meetings. The journal was initially published in German and is still the oldest endocrinological periodical in the German-language market!
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