title: Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors.
abstract: OBJECTIVE
  To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.
  
  
  METHODS
  Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.
  
  
  RESULTS
  In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P < 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P < 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c ≥ 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) < 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI < 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI < 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).
  
  
  CONCLUSIONS
  Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Ihana-Sugiyama
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Yamamoto-Honda
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Eiko
authors.initials: E
authors.lastname: Izawa
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajio
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kakei
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.affiliation: Noriko Ihana-Sugiyama, Ritsuko Yamamoto-Honda, Hiroshi Kajio, Mitsuhiko Noda, Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003113:Colonoscopy; D003248:Constipation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003672:Defecation; D048909:Diabetes Complications / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005243:Feces / Q000737:chemistry*; D005260:Female; D006244:Hardness; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Decreased passage of stools; Diabetic complications; Functional bowel disease; Gastrointestinal symptom rating scale