Status and influencing factors of gastrointestinal autonomic neuropathy in elderly patients with type 2 di-abetes mellitus
Objective To investigate the status of gastrointestinal autonomic neuropathy in elderly patients with type 2 diabetes mellitus(T2DM),and to explore the influencing factors of gastrointestinal autonomic neuropathy in elderly pa-tients with T2DM.Methods Convenience sampling was used to select elderly T2DM patients admitted to the Endocrinol-ogy Department of Yan'an University Affiliated Hospital and Wuqi County People's Hospital from August 2022 to May 2023 as the research subjects.General data questionnaire,Complex autonomic Symptom Score 31(COMPASS-31),Zung Self-rating Anxiety Scale(SAS),Zung Self-rating Depression Scale(SDS)and Pittsburgh Sleep Quality Index(PSQI)were used to collect data.Risk odds ratio(OR)was used to analyze the risk relationship between gastrointestinal autonom-ic neuropathy,psychological status and sleep quality in elderly patients with T2DM.The risk factors of gastrointestinal au-tonomic neuropathy were analyzed by binary logistic regression.Results A total of 324 patients were included,of which 188 cases(58.02%)had concomitant gastrointestinal autonomic neuropathy(COMPASS-31 score≥1);73.9%(139/188)of patients with combined gastrointestinal autonomic neuropathy had constipation,accounting for the highest proportion;49.5%(93/188)had symptoms related to gastric autonomic neuropathy,mainly manifested as early satiety or postprandial fullness;18.10%(34/188)had diarrhea,and 9.04%(17/188)had alternating diarrhea/constipation.Among patients with gastrointestinal autonomic neuropathy,63.3%(88/139)had frequent or persistent constipation fre-quency,and 79.9%(111/139)had moderate to severe constipation severity;Stomach symptom dimension:72.0%(67/93)experienced severe early satiety or postprandial bloating;Diarrhea dimension:Among patients with diarrhea,47.1%(16/34)had frequent or persistent diarrhea frequency,and 73.5%(25/34)had moderate to severe diarrhea se-verity.The incidence of anxiety and depression in patients with gastrointestinal autonomic neuropathy was 16.0%and 41.5%,respectively,and the incidence of poor sleep quality(PSQI score 11-21)was 42.0%,which was 8.414 times,6.179 times and 3.218 times higher than that in patients without gastrointestinal autonomic neuropathy,respectively.The results of binary logistic regression analysis showed that low-density lipoprotein(OR=0.502),disease duration(OR=2.282 for 10-19 years,OR=3.406 for 20 years or more),and depression(OR=6.075)were independent influenc-ing factors of gastrointestinal autonomic neuropathy in elderly T2DM patients(all P<0.05).Conclusions The inci-dence of gastrointestinal autonomic neuropathy is relatively high in elderly T2DM patients,with constipation being the most common symptom,followed by stomach discomfort,manifested as early satiety,postprandial satiety,and diarrhea occurring relatively infrequently but also frequently.Patients with gastrointestinal autonomic neuropathy exhibit moderate to severe levels of gastrointestinal related symptoms,and these symptoms occur more frequently.The risk of anxiety,de-pression,and poor sleep quality increases in elderly T2DM patients with gastrointestinal autonomic neuropathy.Low den-sity lipoprotein,disease duration,and depression are independent risk factors for gastrointestinal autonomic neuropathy in elderly T2DM patients.
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