Dyspepsia in a Patient with Uncontrolled Type 2 Diabetes Mellitus: a Case Report

Abstract

Type 2 diabetes mellitus (DM) and dyspepsia are frequently found together in primary care and share irregular eating patterns as a common factor that can worsen glycemic control while triggering gastrointestinal symptoms. This case report aims to describe the relationship between irregular eating patterns and dyspeptic complaints in a patient with uncontrolled type 2 DM. A 49-year-old woman presented with intermittent epigastric pain and nausea without vomiting for five days, worse when meals were delayed, with similar recurrent complaints over the preceding three months. She had a three-year history of type 2 DM treated with metformin and glimepiride, yet still complained of polyphagia and polyuria. Her diet was poorly controlled, with large portions of rice and carbohydrate-rich snacks, and she had low physical activity. Physical examination revealed epigastric tenderness without alarm features, and a body mass index of 24.2 kg/m² (overweight by Asia-Pacific criteria). Fasting blood glucose (FBG) was 167 mg/dL, up from 129 mg/dL one month earlier. HbA1c testing and endoscopy were not performed, so the condition was classified as uninvestigated dyspepsia and managed empirically on clinical grounds. Treatment consisted of metformin 500 mg twice daily, antacid, omeprazole 20 mg twice daily, and domperidone 10 mg three times daily, together with education, low-carbohydrate dietary modification, and advice on physical activity. At follow-up, epigastric pain and nausea had resolved, polyphagia and polyuria improved, and FBG fell to 135 mg/dL without significant adverse effects. These short-term findings cannot be generalized because of limited data. This case suggests that improving meal regularity may be a relevant point of intervention for both conditions simultaneously.