Examining the Link Between Diabetes and Exocrine Pancreatic Insufficiency

MARCH 17, 2016
Andrew Smith
A new review of 50 original studies concludes that, among patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM), modest amounts of exocrine pancreatic insufficiency and moderate-to-severe subclinical pancreatic fibrosis often occur in the absence of pancreatitis.
The investigators identified and extracted data from research describing the morphological, structural and functional changes of the exocrine pancreas in patients with T1DM and T2DM. They then analyzed the combined data and observed a number of relationships that had gone largely or wholly unnoticed by the authors of the original studies.
Pancreatic weight and volume are significantly lower in T1DM patients — but not in T2DM patients — than in controls matched for age sex and body mass index (p < 0.005). Autopsies of 1,272 diabetic patients, moreover, usually found mild-to-marked interacinar fibrosis, scant inflammatory infiltrate, no pancreatic ductal changes, and hyalinization of arteries. Also, the pooled prevalence of decreased fecal elastase 1 (<200 [mu]g/g) is higher in diabetic patients than in matched controls, but the coefficient of fat absorption is near normal (mean, 91%-94%), and pancreatic exocrine dysfunction does not progress over time.
“In types 1 and 2 diabetes mellitus, moderate-to-severe subclinical pancreatic fibrosis and modest exocrine dysfunction occurs in the absence of clinical or histopathological evidence of chronic pancreatitis,” the authors of the review wrote in Pancreas. “We call this novel entity ‘diabetic exocrine pancreatopathy.’”
Numerous other studies have found links between diabetes and exocrine pancreatic insufficiency. A 2003 study that appeared in Pancreatology, for example, found that both T1DM and T2DM patients suffer very high rates of exocrine pancreatic insufficiency. Some 22.9% of 1.021 diabetic patients were found to have severely reduced fecal elastase 1 concentrations (concentrations < 100 microg/g).

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