Gastrointestinal symptoms as comorbid manifestations of type 1 diabetes mellitus in children

Abstract

Introduction. The incidence of type 1 diabetes mellitus among children and adolescents worldwide is characterized by significant variability, ranging from 5 to 50 new cases per 100,000 individuals under 20 years of age per year, with an average of approximately 14 cases per 100,000. The peak incidence occurs in the 10–14-year age group. After puberty, incidence rates decrease in young women but remain relatively high in young men under 20 years of age. Type 1 diabetes mellitus in childhood is a chronic autoimmune disease accompanied not only by impaired carbohydrate metabolism but also by damage to various organs and systems. Increasing attention is being paid to gastrointestinal disorders in children with type 1 diabetes, as these disorders may occur already in the early stages of the disease, even in the absence of classic microvascular and macrovascular complications.

Aim. The aim of the study was to assess the frequency and intensity of gastrointestinal symptoms in children with type 1 diabetes and to compare the clinical profile of gastrointestinal disorders with that of the control group.

Materials and Methods. The study was conducted as a comparative cross-sectional clinical study. It included 49 children with type 1 diabetes who were under observation in a specialized endocrinology department, as well as 49 children in the control group. The control group consisted of children without diabetes mellitus, chronic gastrointestinal diseases, acute infectious diseases at the time of examination, celiac disease, inflammatory bowel disease, or medication use that could affect the motility or function of the digestive system.

Results. In children with type 1 diabetes, gastrointestinal symptoms were significantly more frequent and more pronounced than in healthy peers, with significantly higher rates of reflux, abdominal pain, nausea, vomiting, diarrhea, and constipation observed in the diabetes group (all p<0.05). For several symptoms, median values were the same in both groups or equal to zero; however, the type 1 diabetes group had wider interquartile ranges, higher percentile values, and greater variability. The most pronounced intergroup differences were observed for pain, nausea, and diarrhea, which were characterized not only by higher frequency but also by greater intensity of manifestations. Individual upper and lower gastrointestinal symptoms in children with type 1 diabetes tended to occur in combination.

Conclusions. In children with type 1 diabetes, gastrointestinal symptoms are systemic and clinically significant. The results indicate an increased frequency and severity of symptoms from different parts of the gastrointestinal tract in children with type 1 diabetes.