Cohort study of clinical and anamnestic characteristics of patients with a combination of type 2 diabetes mellitus and irritable bowel syndrome

Background. Among all diseases of the endocrine system, type 2 diabetes mellitus (DM2) has the highest prevalence, the risk of developing vascular complications and its impact on prognosis. However, among the wide range of complications of diabetes, functional changes in the intestine are not sufficiently represented and studied.

Objective. Prospective evaluation of the clinical and anamnestic characteristics of patients with irritable bowel syndrome (IBS) in combination with DM2 compared with individuals with IBS without diabetes.

Methods. 107 patients were followed-up, 42 (39.3%) men and 65 (60.7%) women aged from 36 to 66 years (mean age – 48.9±9.4 years) with DM2 and the presence of clinical manifestations of IBS, in addition, 52 patients with IBS without diabetes, including 21 (40.4%) were men and 31 (59.6%) women (mean age – 43.7±6.8 years). There were no differences in gender and age between the groups (P>0.05). The study subjects were represented by patients with a combination of IBS and DM2, as well as isolated IBS, whose complaints and anamnesis were assessed, and standard objective and laboratory examinations were performed in accordance with modern recommendations. The severity of clinical manifestations of IBS was assessed using the GSRS questionnaire, and a survey for the presence of psycho-emotional stress, previous gastrointestinal infection and COVID-19 was conducted. In a number of patients, fibrogastroduodenoscopy and fibrocolonoscopy were performed, followed by a morphological examination of biopsy specimens, and the presence of antibodies to gliadin and tissue transglutaminase was determined.

Results. Among diabetic patients, IBS with diarrhea (IBS-D) was represented in 45.8% of cases, patients with IBS with constipation (IBS-C) accounted for 33.6%, 12.2% had mixed (IBS-M) and 8.4% – undifferentiated (IBS-U) form of IBS. Compared with the group of IBS patients without diabetes, those with DM2 more often had IBS-D and IBS-M variants, in the absence of significant differences when examining histological biopsies of the colon mucosa. In diabetic patients with IBS, compared with the group of patients without diabetes and IBS, the frequency of gastrointestinal manifestations, which were associated with overweight, obesity and metabolic syndrome, chronic stress, anxiety, and previous COVID-19 infection, was significantly higher. An increase in the proportion of IBS-D, IBS-M and undifferentiated IBS (IBS-U) was also found in patients with previous severe psycho-emotional stress, acute gastrointestinal infection, taking non-steroidal anti-inflammatory drugs, antibiotics, as well as a previous COVID-19 infection, while the connection between smoking and hypothyroidism and IBS was observed much less frequently.

Conclusion. Diabetic patients with IBS have a number of clinical and anamnestic features that distinguish them from patients with IBS without diabetes, which should be taken into account when choosing the optimal treatment tactics.