title: Association of diabetes and HbA1c levels with gastrointestinal manifestations.
abstract: OBJECTIVE
  To determine the prevalence of gastrointestinal (GI) manifestations associated with diabetes mellitus (DM) in a Taiwanese population undergoing bidirectional endoscopies.
  
  
  METHODS
  Subjects voluntarily undergoing upper endoscopy/colonoscopy as part of a medical examination at the National Taiwan University Hospital were recruited during 2009. Diagnosis of DM included past history of DM, fasting plasma glucose ≥ 126 mg/dL, or glycated hemoglobin (HbA(1c)) ≥ 6.5%. Comparisons were made between diabetic and nondiabetic subjects, subjects with lower and higher HbA(1c) levels, and diabetic subjects with and without complications, respectively, for their GI symptoms, noninvasive GI testing results, and endoscopic findings.
  
  
  RESULTS
  Among 7,770 study subjects, 722 (9.3%) were diagnosed with DM. The overall prevalence of GI symptoms was lower in DM subjects (30.3 vs. 35.4%, P = 0.006). In contrast, the prevalence of erosive esophagitis (34.3 vs. 28.6%, P = 0.002), Barrett's esophagus (0.6 vs. 0.1%, P = 0.001), peptic ulcer disease (14.8 vs. 8.5%, P < 0.001), gastric neoplasms (1.8 vs. 0.7%, P = 0.003), and colonic neoplasms (26.6 vs. 16.5%, P < 0.001) was higher in diabetic subjects. Diagnostic accuracy of immunochemical fecal occult blood test for colonic neoplasms was significantly decreased in DM (70.7 vs. 81.7%, P < 0.001). Higher HbA(1c) levels were associated with a decrease of GI symptoms and an increase of endoscopic abnormalities. Diabetic subjects with complications had a higher prevalence of colonic neoplasms (39.2 vs. 24.5%, P = 0.002) than those without.
  
  
  CONCLUSIONS
  DM and higher levels of HbA(1c) were associated with lower prevalence of GI symptoms but higher prevalence of endoscopic abnormalities.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ping-Huei
authors.initials: PH
authors.lastname: Tseng
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.forename: Chien-Chuan
authors.initials: CC
authors.lastname: Chen
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Tu
authors.forename: Wei-Shiung
authors.initials: WS
authors.lastname: Yang
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000378:metabolism*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D006442:Glycated Hemoglobin