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Lower gastrointestinal symptoms are associated with worse glycemic control and quality of life in type 1 diabetes mellitus
  1. John S Leeds1,
  2. Marios Hadjivassiliou2,
  3. Solomon Tesfaye3,
  4. David S Sanders1
  1. 1 Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK
  2. 2 Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
  3. 3 Department of Diabetes, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to Dr John S Leeds; j.leeds{at}


Objectives Lower gastrointestinal symptoms are not well characterized in people with type 1 diabetes, and the effects on quality of life and glycemic control are unknown. This study aimed to determine the prevalence of lower gastrointestinal symptoms and the effects on glycemic control and quality of life, and to investigate for underlying causes.

Research design and methods This is a prospective, cohort study in secondary care. Patients with type 1 diabetes completed a gastrointestinal symptom questionnaire and the Short Form 36 V.2 quality of life questionnaire and had their hemoglobin A1c measured. Patients with diarrhea were offered reassessment and investigation as per the national guidelines. Controls without diabetes were used to compare symptom prevalence and quality of life scores.

Results 706 with type 1 diabetes (mean age 41.9 years) and 604 controls (mean age 41.9 years) were enrolled. Gastrointestinal symptoms were significantly more frequent in type 1 diabetes compared with controls, in particular constipation (OR 2.4), diarrhea (OR 2.5), alternating bowel habit (OR 2.1), abdominal pain (OR 1.4), floating stools (OR 2.7), bloating (OR 1.4) and flatulence (OR 1.3) (all p<0.05). Previous pancreatitis was more frequent in type 1 diabetes (OR 4.6), but other gastrointestinal conditions were not. Gastrointestinal symptoms were associated with poorer glycemic control (p<0.01) and worse quality of life particularly in those with diarrhea. Investigation of those with diarrhea, including those with alternating bowel habit, (n=105), identified a cause in 72.3% with subsequent change in management.

Conclusions Gastrointestinal symptoms are twice as common in type 1 diabetes and associated with poorer quality of life and glycemic control. Investigation of diarrhea in people with type 1 diabetes leads to a high yield of treatable conditions and a change in management in about three-quarters.

  • Type 1 diabetes
  • diarrhea
  • constipation
  • quality of life

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  • Funding The Bardhan Research and Education Trust of Rotherham and Solvay.

  • Competing interests None declared.

  • Ethics approval North Sheffield Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent Not required.

  • Contributors JSL and DSS conceived and designed the study. JSL, MH, ST and DSS acquired, analyzed and interpreted the data. JSL and DSS drafted the manuscript. JSL, MH, ST and DSS critically revised the manuscript for important intellectual content. JSL and DSS performed the statistical analysis. DSS and JSL obtained funding. MH, ST and DSS provided technical and material support. MH, ST and DSS provided study supervision. All authors had access to the study data and have reviewed and approved the final manuscript. DSS is the guarantor for the study.

  • Data statement No additional data are available.

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