Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3385–3393 | Cite as

Pathophysiology, Differential Diagnosis, and Treatment of Diabetic Diarrhea

  • Alexandra Selby
  • Zachary Wilmer Reichenbach
  • Gregory Piech
  • Frank K. FriedenbergEmail author


Type I diabetes mellitus (DM) affects 0.5% of the US population, with type II DM affecting 8.5% [1]. There are a multitude of complications attributed to DM including gastrointestinal dysfunction [2] with up to 75% of patients experiencing gastrointestinal symptoms, usually in the setting of autonomic neuropathy [3, 4]. Females with DM have an overall increased likelihood of experiencing gastrointestinal symptoms as compared with males [5, 6]. Gastrointestinal symptoms often, but not invariably, correlate with glycemic control as well as the duration of DM [6]. Chronic watery diarrhea, among the most debilitating gastrointestinal symptom due to DM, is termed diabetic diarrhea (DD).

The pathophysiology of DD is complex. Although hyperglycemia-induced neuropathy of the enteric nervous system is a likely cause, other causes include loss of the interstitial cells of Cajal (ICC) and enteric glial cells (ECG), oxidative stress, and inflammation, pathologies that all impair...


Diabetes Diarrhea Motility Enteric nervous system 



Advanced glycation end-products


Diabetic diarrhea


Diabetes mellitus


Enteric glial cells


Inflammatory bowel disease


Diarrhea-predominant irritable bowel syndrome


Interstitial cells of Cajal


Insulin-like growth factor-1


Nitric oxide synthase


Pancreatic exocrine insufficiency


Stem cell factor


Small intestinal bowel overgrowth


Author’s contribution

AS, PGY-2, resident in internal medicine, wrote the manuscript, contributed to the final edits, and approved the final manuscript. ZWR, PGY-5, fellow in gastroenterology, wrote the manuscript, contributed to the final edits, and approved the final manuscript. GP, PGY-5, fellow in gastroenterology, wrote the manuscript, contributed to the final edits, and approved the final manuscript. FF developed the topic and outline of the manuscript, contributed to the final edits, and approved the final manuscript.

Conflicts of interest

None of the authors declare a conflict of interest relevent to information or medical products discussed in this manuscript.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alexandra Selby
    • 1
  • Zachary Wilmer Reichenbach
    • 2
  • Gregory Piech
    • 2
  • Frank K. Friedenberg
    • 2
    Email author
  1. 1.Department of MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA
  2. 2.Section of Gastroenterology and HepatologyLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA

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