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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
MENTORED REVIEW
  • 167 Downloads

Introduction

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...

Keywords

Diabetes Diarrhea Motility Enteric nervous system 

Abbreviations

AGE

Advanced glycation end-products

DD

Diabetic diarrhea

DM

Diabetes mellitus

ECG

Enteric glial cells

IBD

Inflammatory bowel disease

IBS-D

Diarrhea-predominant irritable bowel syndrome

ICC

Interstitial cells of Cajal

IGF-1

Insulin-like growth factor-1

nNOS

Nitric oxide synthase

PEI

Pancreatic exocrine insufficiency

SCF

Stem cell factor

SIBO

Small intestinal bowel overgrowth

Notes

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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© 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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