A new article published in Current Treatment Options in Gastroenterology reported that diabetes mellitus DM can affect the structure and function of the colon promoting commonly encountered lower gastrointestinal symptoms such as constipation diarrhea abdominal distention bloating and abdominal pain. It was stated that specific colonic disorders for which adults with DM are at greater risk include chronic constipation enteropathic diarrhea colorectal cancer CRC inflammatory bowel disease microscopic colitis and Clostridium difficile colitis. The article revealed that smooth muscle structure and function density of the interstitial cells of Cajal and the health and function of the autonomic and enteric nerves of the colon are affected by DM. These effects can result in alterations in colon motility visceral sensation immune function endothelial function and the colonic microbiome. It was suggested that the evaluation and treatment for slow transit constipation as well as pelvic floor dysfunction should be considered when constipation symptoms are refractory to initial treatment measures. Further DM related medications and small bowel conditions such as celiac disease and small intestinal bowel overgrowth should be considered and excluded before a diagnosis of enteropathic diarrhea is made. It was proposed that adults with DM should be appropriately screened and may require a longer bowel preparation to ensure an adequate evaluation given the higher risk of CRC.1 Reference 1. Piper M Saad R. Diabetes Mellitus and the Colon. Current Treatment Options in Gastroenterology. 2017 15 4 460 474. doi 10.1007 s11938 017 0151 1.