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Diabetic diarrhea. Pathophysiology, diagnosis, and management.
1Department of Medicine, Baylor College of Medicine, Houston, Tex 77030.
Archives of Internal Medicine
|February 1, 1990
Summary
Idiopathic diarrhea in diabetes mellitus, often linked to neuropathy, can be managed with targeted therapies. Diagnosis requires careful clinical assessment and laboratory tests to distinguish it from other causes.
Area of Science:
- Gastroenterology
- Endocrinology
- Diabetology
Background:
- Idiopathic diarrhea is a frequent complication in patients with diabetes mellitus.
- It is particularly prevalent in those with poorly controlled insulin-dependent diabetes and evidence of diabetic peripheral and autonomic neuropathy.
Purpose of the Study:
- To review the pathogenesis, diagnosis, and management of idiopathic diarrhea in diabetic patients.
- To differentiate diabetic diarrhea from other gastrointestinal disorders.
Main Methods:
- Clinical assessment and a stepwise laboratory evaluation.
- Review of implicated pathogenic mechanisms including autonomic neuropathy, bacterial overgrowth, and pancreatic exocrine insufficiency.
Main Results:
- Diabetic diarrhea is often intermittent, painless, and can present with steatorrhea or fecal incontinence.
- Multiple pathogenic mechanisms contribute, but a uniform pathogenesis is not established.
- Diagnosis relies on excluding other causes through clinical and laboratory findings.
Conclusions:
- Management of diabetic diarrhea can be challenging.
- Effective therapies include antibiotics for bacterial overgrowth, antidiarrheal agents, clonidine, and somatostatin analogues.