Diabetes mellitus (DM) is one of the most rapidly progressing issues of the 21st
century. Analyzing all editions of the International Diabetes Federation's "Diabetes Atlas"
from 2000 to the 9th edition in 2019, the number of affected individuals is steadily
increasing. As of today, there are 463 million people diagnosed with DM worldwide.
With the persistence of modern lifestyle trends and urbanization, an increase in the
incidence is expected. Despite the undeniable success of modern medicine, diabetes
remains a prominent concern and ranks high among the reasons for seeking medical care
across various specialties.
In recent years, Ukraine, like the rest of the world, has witnessed an increase in the
number of patients with type 2 diabetes. This pathology is characterized by the
development of a range of complications and concomitant diseases, including those
involving the gastrointestinal tract. Although intestinal lesions are typically not a direct
cause of death or disability in patients with type 2 diabetes mellitus, the quality of life of
such patients is significantly reduced, elevating the issue to a position of high relevance.
Type 2 diabetes mellitus is associated with a higher frequency of gastrointestinal
symptoms, including abdominal pain, diarrhea, and constipation, collectively known as
diabetic enterocolopathy (DECP).
Under our observation, there were 138 patients with type 2 diabetes mellitus (T2D),
aged between 39 and 67 years (average age 53 ± 5.1 years). Subsequently, the study
included 117 patients with type 2 diabetes (56 men, 61 women) aged between 39 and 67
8
years. During the initial examination, 21 T2D patients were found to have organic
intestinal pathology and were excluded from the study sample.
The main group consisted of patients with diabetic enterocolopathy associated with
T2D (72 patients, 61.5%), while 45 patients (38.5%) with T2D without intestinal
involvement formed the first comparison group. There were no significant differences
between the main group and the first comparison group in terms of the type and form of
T2D (p < 0.5). Additionally, the second comparison group comprised 60 patients with
irritable bowel syndrome (IBS) aged 35 to 54 years. The control group consisted of 30
practically healthy volunteers who had no gastrointestinal complaints during
comprehensive examination for T2D and were excluded from the study.
Analysis of patient complaints and clinical presentation revealed that clinical
manifestations of diabetic enterocolopathy were characterized by changes in bowel
movements with abdominal pain in 43 out of 72 (59.7%) patients. There were also
patients with changes in bowel movements without abdominal pain - 29 (40.27%), with
19 (26.4%) experiencing constipation, and 10 (13.9%) having diarrhea.
Diabetic enterocolopathy was more common in patients with T2D of longer
duration (over 5 years) and was associated with microangiopathies, manifestations of
autonomic neuropathy, and could be related to the decompensation of the underlying
disease. Risk factors for DECP could include excess body weight, metabolic syndrome,
a history of foodborne toxic infections, gastrointestinal infections, changes in dietary
habits, and stress. The dominant complaints of DECP patients were abdominal pain,
diarrhea, constipation, abdominal distention, and abdominal discomfort.
Microvascular complications and signs of diabetic autonomic neuropathy were
more frequently found in patients with DECP and T2D compared to the comparison
group. Microvascular changes in DECP were observed in 28 (38.9%) patients, while 12
(26.7%) of those in the comparison group were diagnosed with microvascular changes (p
< 0.05). Clinical manifestations of diabetic neuropathy were detected in 25 (34.7%)
patients with DECP and T2D, while only 11 (24.4%) of patients with T2D without
intestinal involvement had these signs (p < 0.05). The clinical association between
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diarrhea and signs of diabetic neuropathy is clear evidence of the significant role of the
autonomic nervous system in its pathogenesis.
Using the polymerase chain reaction (PCR) method, the TGF-β1 gene
polymorphism was examined. According to our data, the single nucleotide polymorphism
TGF-β1*915 G/C, which reduces the synthesis of TGF-β1, played a minor role in the
development of type 2 diabetes and DEP.
Plasma concentrations of TGF-β1 and VEGF were also evaluated. The levels of
TGF-β1 and VEGF in T2D patients significantly exceeded the indicators of healthy
volunteers. In T2D patients with DECP, the levels of growth factors were also
significantly higher than normal (p < 0.05). It was found that the level of TGF-β1 was
highest in patients with DECP and T2D with constipation (26.02 ± 2.31 ng/ml), while
VEGF levels were most significantly elevated in patients with DECP and diarrhea,
surpassing the levels of DEP patients with constipation (p < 0.05).
