S1334 Gastrointestinal Vulnerability in T2DM: Evaluating the Risk of Upper GI Hemorrhage

Introduction: Upper gastrointestinal bleeding is a serious complication in type 2 diabetes mellitus. Despite its significance, the relationship between T2DM related factors and UGIB outcomes remains rather underexplored. Improving this high-risk population’s prognosis requires understanding these relationships. Methods: We conducted a structured literature search using Pubmed and Cochrane library. Our search strategy included key words such as “upper gastrointestinal bleed”, “diabetes mellitus”, “glycemic control”, “diabetic complications”, “mortality” covering studies from inception to May 25, 2025. Over 300 articles were found on the first search, of which 9 articles that met our inclusion criteria were selected. Data was further reviewed for type of study, patient population and other relevant findings of risks and patterns of UGIB in T2DM. Results: Analysis of multiple data shows that poor glycemic index (HbA1c >7.5%) significantly increases risk of rebleeding and mortality in patients with T2DM. Patients with HbA1c >8% had a higher death rate (12% vs 5%) and twice the probability of rebleeding(18% vs 9%) than those with HbA1c <7% in a trial of 100 diabetic patients with UGIB. An Indian study reported that those with >10 yrs diabetes had higher transfusion needs (mean 3.2 vs 1.6 units) and longer stays (9.5 ± 2.1 days vs 6.1 ± 1.8 days) as to shorter duration. A Danish cohort found 47% of diabetes with UGIB were on low dose aspirin and 22% on nonsteroidal anti-inflammatory drugs; these patients had a rebleeding rate of 14.5%, nearly double than those not on these drugs. Limitations include retrospective studies and confounding factors. Conclusion: The likelihood and severity of UGIB in those with T2DM are increased due to poor glycemic control, long disease duration and other comorbidities. Chronic hyperglycemia impairs mucosal healing and compromises vascular integrity thus increasing bleeding risk and reducing potential for recovery. Comorbidities such as cardiovascular disease, chronic kidney disease are associated with longer bleeding, hemodynamic instability and higher 30 day mortality. Those with duration of diabetes over 10 yrs required more transfusions, more ICU admissions and longer hospitalizations. Antithrombotic use in diabetic patients increases risk of bleeding. Effective outcomes and reduced mortality in UGIB patients with T2DM rely on individualized therapeutic strategies.