title: Delayed small intestinal transit in patients with long-standing type 1 diabetes mellitus: investigation of the relationships with clinical features, gastric emptying, psychological distress, and nutritional parameters.
abstract: BACKGROUND
  Studies on small intestinal transit in type 1 diabetes mellitus have reported contradictory results. This study assessed the orocecal transit time (OCTT) in a group of patients with type 1 diabetes mellitus and its relationships with gastrointestinal symptoms, glycemic control, chronic complications of diabetes, anthropometric indices, gastric emptying, small intestinal bacterial overgrowth (SIBO), and psychological distress.
  
  
  METHODS
  Twenty-eight patients with long-standing (>10 years) type 1 diabetes mellitus (22 women, six men; mean age, 39 ± 9 years) participated in the study. The lactulose hydrogen breath test was used to determine OCTT and the occurrence of SIBO. The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. Gastric emptying was measured by scintigraphy. Anthropometric indices included body mass index, percentage body fat, midarm circumference, and arm muscle area.
  
  
  RESULTS
  There was a statistically significant increase in OCTT values in diabetes patients (79 ± 41 min) in comparison with controls (54 ± 17 min) (P=0.01). Individual analysis showed that OCTT was above the upper limit (mean+2 SD) in 30.8% of patients. All anthropometric parameters were significantly decreased (P<0.05) in patients with prolonged OCTT in comparison with those with normal OCTT. In contrast, there was no statistically significant association between prolonged OCTT and gastrointestinal symptoms, peripheral neuropathy, diabetic retinopathy, glycated hemoglobin, delayed gastric emptying, SIBO, anxiety, or depression.
  
  
  CONCLUSIONS
  Small bowel transit may be delayed in about one-third of patients with long-standing type 1 diabetes mellitus. This abnormality seems to have a negative effect on nutritional status in these patients.
authors.affiliation: Division of Gastroenterology, Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Mariza
authors.initials: M
authors.lastname: Faria
authors.forename: Elizabeth João
authors.initials: EJ
authors.lastname: Pavin
authors.forename: Maria Cândida Ribeiro
authors.initials: MC
authors.lastname: Parisi
authors.forename: Sônia Letícia Silva
authors.initials: SL
authors.lastname: Lorena
authors.forename: Sérgio Quirino
authors.initials: SQ
authors.lastname: Brunetto
authors.forename: Celso Dario
authors.initials: CD
authors.lastname: Ramos
authors.forename: Célia Regina
authors.initials: CR
authors.lastname: Pavan
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Mesquita
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D001944:Breath Tests; D003863:Depression / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005746:Gastric Emptying; D005767:Gastrointestinal Diseases / Q000378:metabolism / Q000503:physiopathology* / Q000523:psychology; D005772:Gastrointestinal Transit; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007421:Intestine, Small / Q000378:metabolism / Q000503:physiopathology*; D007792:Lactulose; D008297:Male; D009752:Nutritional Status; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007792:Lactulose; C517652:hemoglobin A1c protein, human