Age, sex, prior complaints predict GI symptoms in adults with new-onset diabetes

Nearly half of individuals with a newly diagnosed type 1 (T1D) or type 2 diabetes (T2D) suffer from gastrointestinal (GI) symptoms, according to a study presented at EASD 2023. These GI adverse events that are associated with glucose-lowering medications occur more frequently among those with already existing GI symptoms prior to treatment initiation.

“Physicians should be aware of previous GI conditions when selecting the appropriate glucose-lowering therapy,” said the researchers, led by A Klötzsch from the German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany.

Klötzsch and colleagues conducted this analysis using data obtained from the German Diabetes Study, an ongoing prospective cohort study on patients with recent adult-onset diabetes (age range, 18‒69 years). They sought to identify risk factors of GI symptoms that can aid in selecting the appropriate medication.

GI symptoms related to glucose-lowering drugs were evaluated during regular annual telephone interviews using standardized questionnaire. Patients who were not taking any glucose-lowering drugs were excluded from the analysis.

Cases included patients ever-reporting GI symptoms due to glucose-lowering medications, while controls included those reporting no GI symptoms and had a maximum diabetes duration of 4 years.

Finally, the research team used logistic regression models to estimate the odds ratios (ORs), adjusting for confounders such as age, sex, diabetes type, waist circumference, smoking, and alcohol, to identify the risk factors associated with GI adverse events.

A total of 262 adults with diabetes (mean age 46.5 years, 46 percent female, 34 percent T1D) were included in the analyses. Cases were identified through the interviews after a mean follow-up of 6.3 years. [EASD 2023, abstract 676]

Of the participants, 54 percent with T1D and 46 percent with T2D reported having any GI symptoms due to glucose-lowering drugs. The most common complaints were frequent bowel movements (eg, diarrhoea, thin stool), occurring in 64 percent and 53 percent of T1D and T2D patients, respectively.

Almost half of prescribed glucose-lowering therapies were changed because of GI complaints by the patients, according to the researchers.

Notably, prior GI disorders before diabetes onset (defined as GI disease or medication, as well as previous complaints like nausea, vomiting, diarrhoea, or constipation) showed with strongest association with the risk of GI symptoms related to glucose-lowering medications (OR, 2.40, 95 percent confidence interval [CI], 1.21‒4.78).

GI symptoms also correlated with the following factors: age (OR per 10-year age increase, 1.32, 95 percent CI, 1.08‒1.63), sex (OR for female sex, 1.28, 95 percent CI, 0.79‒2.09), and waist circumference (OR per 5-cm increase in waist circumference, 1.22, 95 percent CI, 1.09‒1.37).

“Persons with diabetes frequently suffer from GI symptoms, often due to glucose-lowering therapy,” said Klötzsch and colleagues. “As GI symptoms affect quality of life and therapy adherence, it is crucial to understand the reasons why specific persons experience GI disorders to find options for prevention.”