Influence of diabetes mellitus on inflammatory bowel disease course and treatment outcomes. A systematic review with meta-analysis

Dig Liver Dis. 2023 May;55(5):580-586. doi: 10.1016/j.dld.2022.08.017.Epub 2022 Sep 1.


Giacomo Fuschillo 1Valerio Celentano 2Matteo Rottoli 3Guido Sciaudone 1Antonietta Gerarda Gravina 4Raffaele Pellegrino 4Raffaele Marfella 1Marco Romano 4Francesco Selvaggi 1Gianluca Pellino 5


Author information

1Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.

2Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom; Department of Surgery and Cancer. Imperial College, London, United Kingdom.

3Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.

4Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.

5Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: gianluca.pellino@unicampania.it.


Background: Diabetes Mellitus (DM) may occur in IBD and influence the disease progression.

Aim: To compare disease course and treatment outcomes in IBD patients with and without DM.

Methods: This is a systematic review with meta-analysis comparing patients with IBD plus DM with patients with IBD only.

Primary endpoints: need for surgery, IBD-related complications, hospitalizations, sepsis, mortality. Quality of life and costs were assessed.

Results: Five studies with 71,216 patients (49.1% with DM) were included. Risk for IBD-related complications (OR=1.12, I2 98% p = 0.77), mortality (OR=1.52, I2 98% p = 0.37) and IBD-related surgery (OR=1.20, I2 81% p = 0.26) did not differ. Risk of IBD-related hospitalizations (OR=2.52, I20% p < 0.00001) and sepsis (OR=1.56, I2 88% p = 0.0003) was higher in the IBD+DM group. Risk of pneumonia and urinary tract infections was higher in the IBD+DM group (OR=1.72 and OR=1.93), while risk of C. Difficile infection did not differ (OR=1.22 I2 88% p = 0.37). Mean Short Inflammatory Bowel Disease Questionnaire score was lower in the IBD+DM group (38.9 vs. 47, p = 0.03). Mean health care costs per year were $10,598.2 vs $3747.3 (p < 0.001).

Conclusion: DM might negatively affect the course of IBD by increasing the risk of hospitalization and infections, but not IBD-related complications and mortality.

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