The most devastating consequences of diabetes are associated with its long-term micro- and macrovascular complications, and up to 75% of patients with diabetes may experience symptoms of gastrointestinal complications. The pathogenesis of gastrointestinal complications is complex, primarily related to autonomic dysfunction of the gastrointestinal tract and also associated with hyperglycemia and duration of diabetes. Over recent decades, following the identification of multiple gut-derived hormones, the gut has been recognized as the largest endocrine organ in our body. Peptides released from various cells act locally via autocrine and paracrine mechanisms, on distant organs via endocrine mechanisms, and as neurotransmitters in the central and peripheral nervous systems. The association between gut microbiota and type 2 diabetes appears to be mediated through the impairment of butyrate secretion, and a mechanism involving the incretins. There have been alarming increases in autoimmune diseases worldwide in the past several decades. Autoimmunity develops over time; and genetic predisposition, environmental factors such as infections, and gut dysbiosis play important roles in the development of autoimmune diseases.
KeywordsDiabetes mellitus Microvascular complications Autonomic neuropathy Gastrointestinal complications Autoimmune diseases Incretins
- 3.American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S13–27, S55–65.Google Scholar
- 6.Vučković-Rebrina S, Barada A, Smirčić-Duvnjak L. Diabetic autonomic neuropathy. Diabetol Croat. 2013;42–3:73–9.Google Scholar