High prevalence of exocrine pancreatic insufficiency in diabetes mellitus

Hardt, Philip D.; Hauenschild, A.; Nalop, Jens; Marzeion, Axel M.; Jaeger, C.; Teichmann, J.; Bretzel, Reinhard G.; Hollenhorst, Manfred; Kloer, H. U.

doi:10.1159/000073655

Cited by 161 publications

(48 citation statements)

References 38 publications

(41 reference statements)

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“…This could be explained in part by the assumption that pancreatic diabetes mellitus (type-3) must be more frequent than previously believed [4,14,16]. In the general opinion type-3 diabetes has been described to account for about 1% of diabetics [26].…”

Section: Discussionmentioning

confidence: 99%

“…Utilising this non-invasive test, it became possible to screen larger patient groups and several studies used it to investigate larger populations of both, patients with type-1 and type-2 diabetes mellitus. These studies included up to 1000 patients and reported a high prevalence in both, type-1 (50-60%) [14-16] and type-2 diabetes (35-40%) [14,16,17]. Summarizing the results of direct and indirect tests there can be no doubt that exocrine pancreatic insufficiency is very frequent in patients with diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of type-3 diabetes might be higher than believed previously or autoimmune diseases could involve both parts of the gland. While the relevance of these hypotheses is still under debate, some recent studies observed that there is a correlation between FEC and residual beta cell function, quality of diabetes control [24] and diabetes duration [16] suggesting exocrine dysfunction to be a complication of diabetes mellitus. Since the arguments have not been convincing so far, we decided to re-evaluate the records of patients having been hospitalized with the diagnosis of diabetes mellitus in our institution during a 2 year period (01.01.2003-31.12.2004) concerning diabetes classification, diabetes associated parameters and exocrine pancreatic function.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of exocrine pancreatic function as measured by fecal elastase-1 concentrations (FEC) in patients with diabetes mellitus

et al. 2009

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Objective Recently it has been shown that there is not only endocrine insufficiency in diabetic patients, but a frequent co-morbidity of both, the endocrine and exocrine pancreas. The present study was performed to further analyse the determinants of exocrine pancreatic function in patients with diabetes mellitus. Methods The records of 1992 patients with diabetes mellitus who had been treated in our hospital during a 2-year period were re-evaluated. Defined parameters were documented in standardized data sheets. Records were further checked for the results of imaging procedures of the pancreas. In 307 patients FEC had been performed and documented. Only these patients were included in further evaluation. Results FEC was inversely correlated with diabetes duration and HbA1c-levels but not with age. C-peptide levels correlated positively with FEC. BMI and FEC were also significantly correlated. There was no correlation between diabetes therapy and exocrine pancreatic function as there was no correlation with any concomitant medication. The presence of diabetes-associated antibodies was not related to FEC. According to the documented data 38 were classified as type-1 diabetes (12.4%), 167 as type-2 (54.4%), and 88 patients met the diagnostic criteria of type-3 (28.7%). Fourteen patients could not be classified because of lacking information (4.6%). Conclusions Exocrine insufficiency might be explained as a complication of diabetes mellitus. However, it is more likely that type-3 diabetes is much more frequent than previously believed. Consequently the evaluation of exocrine function and morphology should be included into the clinical workup of any diabetic patient at least at the time of manifestation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determinants of exocrine pancreatic function as measured by fecal elastase-1 concentrations (FEC) in patients with diabetes mellitus

et al. 2009

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“…Clinically apparent protein and fat malabsorption does not occur until over 90% of pancreatic exocrine function is lost, but careful clinical studies indicate that a majority of patients with chronic pancreatic disease have some degree of malabsorption [18,111]. In addition, 20–40% of T1DM and T2DM subjects demonstrate abnormal exocrine function according to some investigators [111], although this awaits confirmation and verification that pancreatic enzyme replacement is therapeutic in T1DM and T2DM patients. Steatorrhea due to fat malabsorption typically precedes the onset of protein malabsorption in severe disease, but moderate degrees of fat malabsorption may be undetected by patients and their physicians.…”

Section: Treatment Considerations For T3cdmmentioning

confidence: 99%

Pancreatogenic Diabetes: Special Considerations for Management

2011

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“…Patients with chronic pancreatitis and diabetes mellitus have a pronounced acinar atrophy [23], hence an increased risk to develop PEI (evidence 2B), as evident from reduced fecal elastase-1 both in type 1 and type 2 diabetes mellitus [29]. These patients should also be treated (GCP).…”

Section: Medical Therapy Of Chronic Pancreatitismentioning

confidence: 99%

Conservative Treatment of Chronic Pancreatitis

Löhr

Haas²,

Lindgren³

et al. 2013

Dig Dis

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Background: Chronic pancreatitis is a progressive inflammatory disease giving rise to several complications that need to be treated accordingly. Because pancreatic surgery has significant morbidity and mortality, less invasive therapy seems to be an attractive option. Aim: This paper reviews current state-of-the-art strategies to treat chronic pancreatitis without surgery and the current guidelines for the medical therapy of chronic pancreatitis. Results: Endoscopic therapy of complications of chronic pancreatitis such as pain, main pancreatic duct strictures and stones as well as pseudocysts is technically feasible and safe. The long-term outcome, however, is inferior to definitive surgical procedures such as resection or drainage. On the other hand, the medical therapy of pancreatic endocrine and exocrine insufficiency is well established and evidence based. Conclusions: Endoscopic therapy may be an option to bridge for surgery and in children/young adolescents and those unfit for surgery. Pain in chronic pancreatitis as well as treatment of pancreatic exocrine insufficiency follows established guidelines.

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High prevalence of exocrine pancreatic insufficiency in diabetes mellitus

Cited by 161 publications

References 38 publications

Determinants of exocrine pancreatic function as measured by fecal elastase-1 concentrations (FEC) in patients with diabetes mellitus

Determinants of exocrine pancreatic function as measured by fecal elastase-1 concentrations (FEC) in patients with diabetes mellitus

Pancreatogenic Diabetes: Special Considerations for Management

Conservative Treatment of Chronic Pancreatitis

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