LAUSR

I read with interest the study conducted by Sangnes et al. [1] assessing gastrointestinal (GI) transit, regional pH profile and autonomic function in patients with diabetic diarrhoea (DD) in order to characterize the integrative processes in the enteric nervous system (ENS) and the autonomic nervous system (ANS). The paper is highly relevant as DD is amongst the under-recognized burdensome diabetic complications leading to social limitations and reduced quality of life especially when faecal incontinence is present. It is characterized by painless, chronic (>6 weeks), non-bloody, watery diarrhoea independent of meals, presence of sudden volume increase, alternating hard and loose stools, leakage and faecal incontinence. Clinical evaluation includes differential diagnoses including, for example, pancreatic exocrine insufficiency, small intestinal bacterial overgrowth, coeliac disease and inflammatory bowel disease, but also antidiabetic treatment in itself can also cause softer stools. DD is reported four times more often in patients with poor glycaemic regulation in comparison to those who are well-regulated. This emphasizes the relevance of individual tight glycaemic control and consequently clinicians should inspire and collaborate with patients in lifestyle-changing habits in order to minimize the debilitating symptom burden and tomonitor glucose continuously to gain insight of the episodes and times outside therapeutic range.