Diabetes Is Associated With Higher Symptom Burden in Patients With Disorders of Gut-Brain Interaction: A Multinational Population-Based Study.

AIMS: To compare multidomain symptom burden, psychological distress and healthcare utilisation across individuals with disorders of gut-brain interaction (DGBI) and diabetes and their overlap, and to assess obesity as an effect modifier.

MATERIALS AND

METHODS

We conducted a cross-sectional analysis based on data from the Rome Foundation Global Epidemiology Study. Participants were classified according to self-reported physician-diagnosed diabetes and Rome IV criteria for DGBI. Outcomes included gastrointestinal symptoms, psychological distress (PHQ-4), somatic symptoms (PHQ-12), healthcare utilisation, medication use and dietary intake.

RESULTS

Among 23,939 participants, 20,055 (83.8%) had DGBI only, 2205 (9.2%) had diabetes only and 1679 (7.0%) both. A consistent gradient was observed across most outcomes (overall p < 0.001), with the highest burden in the DGBI-diabetes overlap group, intermediate in DGBI alone and the lowest in diabetes alone. The overlap group exhibited greater gastrointestinal symptom severity (e.g., abdominal pain severity 51.4 ± 21.6 vs. 47.6 ± 22.2 vs. 45.8 ± 26.0), higher somatic symptom burden (7.2 ± 4.1 vs. 6.5 ± 3.7 vs. 4.5 ± 3.4) and increased healthcare utilisation, including more frequent physician visits (34.3% vs. 14.0% vs. 24.5%) compared with the DGBI-only and diabetes-only groups, respectively. Psychological distress was elevated in both DGBI groups compared with diabetes alone (overall p < 0.001). Obesity-modified several associations between DGBI-diabetes overlap and clinical outcomes, with many associations being stronger among participants without obesity.

CONCLUSIONS

Coexisting DGBI and diabetes were associated with greater gastrointestinal and somatic symptom burden and healthcare utilisation, including within the upper gastrointestinal and bowel DGBI domains. Obesity modified several of these associations, with stronger associations generally observed among participants without obesity.