Octreotide treatment of severe diabetic diarrhoea
Octreotide treatment of severe diabetic diarrhoea
复制标题
奥曲肽治疗严重糖尿病腹泻
DOI：
10.1111/j.1445-5994.2003.00494.x
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发表时间：
2003
影响因子：
2.1
通讯作者：
Alicia J. Jenkins
中科院分区：
文献类型：
--
作者：
C. Meyer;David N O'Neal;William R Connell;F. P. Alford;Glenn M. Ward;Alicia J. Jenkins
In diabetes, gastrointestinal function may be disturbed by hyperglycaemia per se and/or autonomic neuropathy. Disturbances of intestinal motility may result in diarrhoea which is usually mild, but rarely overwhelming. This form of diarrhoea is frequently resistant to standard treatments. Octreotide is reported as useful in such cases although it is not an approved indication. We present two type 1 diabetic patients with severe diarrhoea and discuss the aetiology and treatment of diabetic diarrhoea including use of octreotide. Case 1: A 28-year-old woman with 9 years of poorly controlled diabetes (HbA1c 15–20%), presented with 2 years of severe watery diarrhoea. She had several admissions with ketoacidosis and had retinopathy, microalbuminuria, peripheral neuropathy and postural hypotension necessitating fludrocortisone treatment. She had 10–15 bowel actions per day, was incontinent and her weight fell from 120 kg to 45 kg (body mass index (BMI) 37–13.7), leaving her wheelchair bound. Investigations including gastrointestinal endoscopy and biopsies, coeliac antibodies, faecal cultures and fat measurements, and gut hormone levels were normal. Conventional treatments – including dietary manipulation, imodium, loperamide, antibiotics, pancreatic enzyme supplements and cholestyramine – had little effect. Octreotide (0.1 mg s.c. t.d.s) was commenced resulting in marked improvement with only two bowel actions per day. Her HbA1c fell to 7.0% and her weight increased to 61 kg (BMI 19), resulting in great improvements in well-being. Case 2: A 22-year-old woman presented with 8 years of poorly controlled diabetes (HbA1c 10–12%). She had cataracts, microalbuminuria and recurrent urinary infections. Over 4 years she developed worsening diarrhoea with 10–40 bowel actions per day. Her weight fell from 56 kg to 39 kg (BMI 15.2), leaving her virtually housebound. Investigations as above and laxative/diuretic screens were normal. Peripheral neuropathy and cardiac autonomic neuropathy were confirmed. Nuclear medicine transit study demonstrated increased gastric emptying time of >120 min and rapid small and large bowel transit time of 3 h. Treatments as in case 1 were ineffective. Octreotide (0.025 mg sc. t.d.s.) was commenced and increased to 0.0375 mg t.d.s. and 0.05 mg nocte and replaced by monthly i.m. injections of 10 mg of long-acting release octreotide. Bowel action frequency reduced to 1–3 per day, her weight increased to 47 kg and HbA1c reduced to 9%. This clinical improvement was maintained after 12 months of octreotide treatment and she has returned to work and study. In both patients insulin dosage was reduced (20–30%) on octreotide. Also, both patients experienced a recurrence of symptoms within days of octreotide cessation due to supply problems. Symptoms were rapidly ameliorated with reintroduction of the agent. Diabetic diarrhoea is a chronic condition predominantly affecting middle-aged patients with poorly controlled type 1 diabetes. 1 It has a male to female ratio of 3 : 2. 2 The overall incidence is as high as 10–22%, 3
