Gastrointestinal symptoms are reportedly common in diabetes mellitus, but the available epidemiological data are conflicting and can be challenged on methodological grounds. In this cross-sectional study of 15 000 adults in Sydney, Australia, the authors examined the relationship between diabetes mellitus and troublesome gastrointestinal symptoms. Unlike most previous studies, the survey was done in a community setting and incorporated both an adequate control group and a representative diabetic population of all ages and grades of severity. The diabetic population comprised 4.9% of the total population. The authors found that for all gastrointestinal symptoms, occurrence was significantly more frequent in individuals with diabetes compared with controls, even when they adjusted for potential confounding factors. Gastrointestinal symptoms were strongly associated with poor glycemic control but not with the duration of diabetes or the type of diabetic treatment. The study suggests that irreversible autonomic nerve dysfunction is unlikely to be the only factor that explains the observed higher prevalence of gastrointestinal symptoms in diabetes mellitus.