Diabetes and the gut.

The pathophysiology of impaired gastrointestinal function in both chronic diabetes1' 2, and acute ketoacidosis3, remains undefined, although several mechanisms have been implicated. These include autonomic neuropathy4, microangiopathy5, changes in insulin and glucagon release, and acute metabolic disturbance. In recent years various new gastrointestinal hormones have been described6' 7, although their physiological importance remains to be determined8. It is likely that both the chronic, and acute, metabolic changes found in diabetes will modify the release of these hormones and alter their effects on the gut. However, at the present time there are no studies of gut hormone levels in diabetics with gastrointestinal complications and the pathophysiological significance of these substances remains ill-defined. This review will consider both the acute and chronic effects of diabetes mellitus on the gastrointestinal tract alone and will largely be confined to human data.