Type 2 diabetes mellitus is associated with asymptomatic acute abdomen among elderly patients admitted to acute tertiary care hospital wards

Background: Pain may be absent in a substantial proportion of elderly patients with acute abdominal conditions. This study explored the association between type 2 diabetes mellitus (T2DM) and asymptomatic presentation. Methods: We conducted a cross-sectional analysis of 215 patients aged ≥ 65 years admitted with acute abdominal conditions. Demographic, clinical, and laboratory data were extracted from medical records. Descriptive statistics and multivariable logistic regression were used to identify associative predictors of asymptomatic acute abdomen (AAA). Results: The median age was 82 years [77-86]; 54.4% (n = 117) were female; 31.2% (n = 67) had T2DM. Overall, 33.5% (n = 72) presented without abdominal pain. T2DM prevalence was higher in AAA than symptomatic patients (44.4% vs. 24.5%, p < 0.01). In multivariable analysis, T2DM (OR 1.95, 95% CI 1.10-3.45, p = 0.02), lower heart rate (OR 0.83, 95% CI 0.71-0.96, p = 0.01), and absence of fever (OR 0.50, 95% CI 0.26-0.95, p = 0.03) were associated with AAA. Among patients with T2DM, longer diabetes duration (12.5 years [10.5-14.5] vs. 8.8 years [5.0-11.0]; p < 0.01) and higher HbA1c (8.2% [7.2-8.7] vs. 7.5% [6.8-7.6]; p = 0.02) were associated with asymptomatic presentation. Conclusions: Asymptomatic acute abdomen is common among elderly patients. Long-standing and poorly controlled T2DM is associated with absent pain. Prospective studies are needed to clarify causal mechanisms, and early glyco-metabolic assessment may aid recognition of at-risk patients.