Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes

P. Kempler, G. Amarenco, R. Freeman, S. Frontoni, M. Horowitz, M. Stevens, P. Low, R. Pop-Busui, A. A. Tahrani, S. Tesfaye, T. Várkonyi, D. Ziegler, P. Valensi

Research output: Contribution to journalReview article

45 Scopus citations

Abstract

There are substantial advances in understanding disordered gastrointestinal autonomic dysfunction in diabetes. It occurs frequently. The underlying pathogenesis is complex involving defects in multiple interacting cell types of the myenteric plexus as well. These defects may be irreversible or reversible. Gastrointestinal symptoms represent a major and generally underestimated source of morbidity for escalating health care costs in diabetes. Acute changes in glycaemia are both determinants and consequences of altered gastrointestinal motility. 35-90% of diabetic men have moderate-to-severe erectile dysfunction (ED). ED shares common risk factors with CVD. Diagnosis is based on medical/sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to patient's complaints and risk factors. Treatment is based on PDE5-inhibitors (PDE5-I). Other explorations may be useful in patients who do not respond to PDE5-I. Patients at high cardiovascular risk should be stabilized by their cardiologists before sexual activity is considered or ED treatment is recommended. Estimates on bladder dysfunction prevalence are 43-87% of type 1 and 25% of type 2 diabetic patients, respectively. Common symptoms include dysuria, frequency, urgency, nocturia and incomplete bladder emptying. Diagnosis should use validated questionnaire for lower urinary tract symptoms. The type of bladder dysfunction is readily characterized with complete urodynamic testing. Sudomotor dysfunction is a cause of dry skin and is associated with foot ulcerations. Sudomotor function can be assessed by thermoregulatory sweat testing, quantitative sudomotor axon reflex test, sympathetic skin response, quantitative direct/indirect axon reflex testing and the indicator plaster.

Original languageEnglish (US)
Pages (from-to)665-677
Number of pages13
JournalDiabetes/Metabolism Research and Reviews
Volume27
Issue number7
DOIs
StatePublished - Oct 2011

Keywords

  • Bladder dysfunction
  • Erectile dysfunction
  • Gastrointestinal autonomic neuropathy
  • Gastroparesis
  • Sudomotor dysfunction

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Kempler, P., Amarenco, G., Freeman, R., Frontoni, S., Horowitz, M., Stevens, M., Low, P., Pop-Busui, R., Tahrani, A. A., Tesfaye, S., Várkonyi, T., Ziegler, D., & Valensi, P. (2011). Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes. Diabetes/Metabolism Research and Reviews, 27(7), 665-677. https://doi.org/10.1002/dmrr.1223