Overview of gastrointestinal disorders due to diabetes mellitus: emphasis on nutritional support.

Gastrointestinal disorders associated with diabetes mellitus have a prevalence rate of 30 to 75%. The most prominent disorders are gastroparesis, diarrhea, and constipation. Severity of symptoms range from mild to severe with the most affected patients being at risk for the development of protein calorie malnutrition. An historical review of the major studies which defined the diagnosis, pathophysiology, and prevalence of these disorders is presented. Guidelines for accurate nutritional assessment, which is essential to the decision to initiate nutritional therapy in this difficult to assess population, are also included. Current methods devised for treatment of diabetic gastroparesis and related disorders are presented. Emphasis is placed on recent developments in nutritional support techniques which make it possible to meet the energy requirements of all such patients. Practical outlines for glucose control in patients receiving TPN or enteral feeding and guidelines for transitioning from parenteral feeding to an oral diet are also presented.