Efficacy of Linaclotide in Type II Diabetics With Chronic Constipation
Efficacy of Linaclotide in Type II Diabetics With Chronic Constipation
Study includes 5 visits, when all basic clinical information, vital signs, symptoms, and side
 effects are going to be assessed at each appointment.

 Patients are going to be assigned by the computer, to receive an active or non-active drug
 for 14 days in a first phase. The order will be change during the second phase. The 2 weeks
 break without our medication will separate these phases. A very close observation regarding
 safety of our subjects will be implemented by study personnel and clinical investigators.
The symptoms of chronic constipation are defined as infrequent bowel movements, hard stool,
 straining during defecation, bloating, abdominal discomfort, and sensation of incomplete
 evacuation.

 Constipation has been reported as a common complication of diabetic neuropathy. A new
 medication, called linaclotide, was studied on many patients, and it is approved to be on a
 market for constipated patients. Unfortunately diabetics were not included in these previous
 studies; hence we designed the project which is going to address the possible benefit of this
 drug in diabetic population.
Inclusion Criteria:

 -  Type II diabetics.

 -  Functional Constipation defined by Rome III criteria are as follows: a. At least a 6
 months history of constipation.

 b. Less than three spontaneous bowel movements (SBMs) per week. c. At least 25% of
 stools are lumpy or hard stools as it is described in Bristol Stool Form Scale (BSFS)
 less than score of 6.

 d. Sensation of incomplete evacuation following at least 25% of bowel movements.

 e. Straining on at least 25% of defecations. f. Sensation of anorectal
 obstruction/blockage for at least 25% of defecations.

 Note: The above criteria are only applicable to spontaneous bowel movements. Patients who
 have no spontaneous bowel movements (bowel movements are preceded by laxative intake) are
 considered constipated and are eligible for this study.

 -  For patients' ≥ 50 years of age, normal colonic anatomy as documented by colonoscopy
 or double-contrast barium enema, performed within the previous 5 years, based on the
 American Gastroenterological Association guidelines.

 -  Patients with confirm diagnosis of Diabetic Autonomic Neuropathy based on results of
 ANX 3.0, real-time ANS monitoring system will be included in this investigation.

 -  Patients diagnosed with diabetic peripheral neuropathy and/or symptoms of functional
 gastroduodenal disorders, such as GERD and functional dyspepsia may participate in a
 study.

 Exclusion Criteria:

 -  Pregnancy or lactation

 -  Subjects unwilling to practice adequate contraception throughout the period of
 screening through 14 days after study termination.

 -  Loose or watery stools reported in the absence of laxatives for >25% of BMs during the
 screening period by using Bristol Stool Form Scale (BSFS).

 -  Use of laxatives 3 days immediately prior to randomization (except fiber or bulking
 agents) and chronic laxative use during the trial.

 -  Patients diagnosed with severe, drug refractory gastroparesis (persistent daily
 vomiting), currently receiving parenteral feeding (N-G, J-G-Tubes), having history of
 frequent hospitalizations, or being implanted with gastric neurostimulation system.

 -  Use of any of the following drugs within 3 days prior randomization and during the
 trial: a. Prokinetic agents (domperidone, metoclopramide, erythromycin).

 b. Medication containing opiates. c. Anti-spasmodic (e.g. Atropine, hyoscamine,
 scopolamine, glycopyrrolate).

 -  Hemoglobin A1c>8.2

 -  Use of illegal drugs.

 -  Regular consumption of more than 2 drinks of alcohol per day

 -  Chronic, more than 3/week use of NSAIDs.

 -  Patients with prolonged straining/push during BMs suggesting severe pelvic floor
 dysfunction.

 -  History or current diagnosis of diverticulitis and severe hemorrhoids.

 -  History of gastric resections, partial colon resection, history of rectocele.

 -  Existence of any major medical condition such as malignancy, severe renal and liver
 diseases, which in the decision of PI should be excluded from participation.