@article {Leedse000514, author = {John S Leeds and Marios Hadjivassiliou and Solomon Tesfaye and David S Sanders}, title = {Lower gastrointestinal symptoms are associated with worse glycemic control and quality of life in type 1 diabetes mellitus}, volume = {6}, number = {1}, elocation-id = {e000514}, year = {2018}, doi = {10.1136/bmjdrc-2018-000514}, publisher = {BMJ Specialist Journals}, abstract = {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.}, URL = {https://drc.bmj.com/content/6/1/e000514}, eprint = {https://drc.bmj.com/content/6/1/e000514.full.pdf}, journal = {BMJ Open Diabetes Research and Care} }