Diabetic Nephropathy with Proteinuria Is the Risk of Indigestion Symptoms in Patients with Diabetes Mellitus—A Multicenter Survey in Japan
Authors: NAMIKI YULIA , YAMADA EIJI , TAKANO YUYA , TAKAMINE HIKARU , SASAKI HIROTO , INAZUMI KOJI , MINAMI TAICHI , ITO SATOSHI , MANTANI NAOKI , IWASAKI TOMOYUKI , YAMADA MASAYO , NAKAJIMA ATSUSHI , TERAUCHI YASUO , OSADA URU N. 
Published: June 2018

Patients with end stage renal disease frequently show indigestion symptoms as a result of uremia. However, the association between the indigestion symptoms and the earlier stage of diabetic nephropathy is unclear. Therefore we conducted a multicenter study using self-administered questionnaires: the Gastrointestinal Symptom Rating Scale (GSRS).Patients were type1 or type 2 DM between 20-85 years old treated in 2 hospitals and 3 clinics in Yokohama and Tokyo during June 2016 to January 2017. We excluded patients if they were either 1) pregnant or 2) suffering from malignant disease or digestive disease. We defined diabetic nephropathy as stage 3 or later and clinically significant indigestion symptoms (CSIS) as GSRS≧3. We analyzed the association between diabetic nephropathy and CSIS.In total of 722 patients, 430 (61%) were male and 36 (5%) were Type 1 DM. Mean age was 65 years old, mean BMI was 25.0, mean HbA1c was 7.5% and mean duration of DM was 155 months. As for diabetic microangiopathy, 177 (26%) had nephropathy, 186 (30%) had peripheral neuropathy, 180 (29%) had retinopathy. GLP-1 receptor agonists were used in 62 (8.8%) patients. In comparison between patients with and without CSIS, age, BMI, HbA1c were not different. Duration of DM was longer in CSIS (193 ± 19 vs. 153 ± 5 months, p=0.046). Presence of diabetic nephropathy was associated with CSIS (OR=2.08, 95% CI: 1.10-3.91), in contrast, that of neuropathy and retinopathy was not. In multivariate analysis adjusting age, BMI, HbA1c and use of GLP-1 receptor agonist, CSIS were significantly associated with longer duration of DM (β=0.003, SD=0.001, p=0.01), and diabetic nephropathy (OR=1.95, 95% CI:1.01-3.71). Neuropathy and retinopathy had no significant association with CSIS. Our results suggest that not only in the end stage renal disease, earlier stage of diabetic nephropathy with proteinuria might be the risk of indigestion symptoms in patients with diabetes mellitus.

Disclosure
Y. Namiki: None. E. Yamada: None. Y. Takano: None. H. Takamine: None. H. Sasaki: None. K. Inazumi: None. T. Minami: None. S. Ito: None. N. Mantani: None. T. Iwasaki: None. M. Yamada: None. A. Nakajima: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi & Co., Ltd.. Speaker's Bureau; Self; Shionogi & Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited. U.N. Osada: None.