Associations of oral hypoglycemic use, fruit intake, and diabetes duration with gastrointestinal autonomic dysfunction in type 2 diabetes patients in Zanzibar

Background Gastrointestinal autonomic dysfunction (GAD) is a common complication of Type 2 Diabetes Mellitus (T2DM) leading to gastroparesis, constipation, and gastroesophageal reflux disease, consequently affecting the overall quality of life. However, its prevalence and risk factors remain underexplored, particularly in low-resource settings like Zanzibar. This study assessed the prevalence of GAD and its associations with pharmacological, clinical, and lifestyle factors among T2DM patients in Zanzibar using the Composite Autonomic Symptom Score (COMPASS 31) questionnaire. Methods A cross-sectional study was conducted among 364 T2DM patients attending clinics in Zanzibar. Participants were recruited from local healthcare facilities, and data were collected through structured interviews. The gastrointestinal subdomain of the COMPASS 31 questionnaire quantified symptoms of gastrointestinal dysfunction. Descriptive and inferential analyses were performed to explore prevalence and associated factors. Results Among 364 participants, 140 (38.4%) had GAD. Longer diabetes duration was significantly associated with GAD, with those having diabetes for 7-9 years (adjusted OR: 2.19, p = 0.050) and > 10 years (adjusted OR: 2.04, p = 0.036) at higher risk. Use of oral hypoglycemic agents, more common in those with shorter disease duration, was linked to significantly lower odds of GAD (adjusted OR: 0.43, p = 0.007) compared to insulin alone. Additionally, consuming > 2 portions of fruit per day was associated with reduced risk (adjusted OR: 0.41, p = 0.019). Other factors, including gender and BMI, showed trends but were not statistically significant. Conclusion GAD is common among T2DM patients in Zanzibar, with longer diabetes duration increasing risk, while oral hypoglycemic use and higher fruit intake are linked to lower risk. The protective association of oral hypoglycemics may reflect earlier disease stages, reinforcing the importance of early diagnosis and intervention. Findings highlight the need for integrated lifestyle and pharmacological approaches to mitigate autonomic complications. Future research, including longitudinal studies and clinical trials, should explore causal relationships, underlying mechanisms, and the impact of dietary modifications and pharmacological interventions on GAD.