Chapter 79
Pancreatic Exocrine Insufficiency in Type 1 and Type 2 Diabetes Mellitus
Lessons from Pancreatologists to Diabetologists
Philip D. Hardt,
Philip D. Hardt
Department of Gastroenterology, University Hospital Giessen, Giessen, Germany
Search for more papers by this authorPhilip D. Hardt,
Philip D. Hardt
Department of Gastroenterology, University Hospital Giessen, Giessen, Germany
Search for more papers by this authorBook Editor(s):J. Enrique Domínguez-Muñoz MD, PhD,
J. Enrique Domínguez-Muñoz MD, PhD
Director
Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorFirst published: 16 April 2021
Summary
Typical clinical symptoms of diabetes mellitus have been described as early as 1500 bc in the Ebers Papyrus. When sufficient indirect tests of exocrine pancreatic function became available, it enabled researchers to study larger groups of patients. In the first single-center study in 30 patients with T1D and 83 patients with T2D, exocrine insufficiency was demonstrated in 56.7% and 35%, respectively, as compared to 18.1% in controls. It can be concluded that the finding of pancreatic exocrine insufficiency in diabetic patients is much more common than in age-matched controls and that fecal fat digestion is also altered in these patient. There are some autopsy studies reporting morphological changes of the exocrine pancreas in patients with diabetes mellitus. The possible coexistence of exocrine pancreatic disease and diabetes mellitus has relevant implications for the clinical treatment of affected patients.
References
- Modlin IM, Hults C, Kidd M, Hinoue T. A historical and critical appraisal of chronic pancreatitis. In: MW Büchler, H Friess, W Uhl, P Malfertheiner (eds) Chronic Pancreatitis: Novel Concepts in Biology and Therapy. Oxford: Blackwell Science, 2002: 3–26.
- Modlin IM, Kidd M. The Paradox of the Pancreas: From Wirsüng to Whipple. Hannover, Germany: Solvay Pharmaceuticals, 2003.
- Cawley T. A singular case of diabetes, consisting entirely in the quality of the urine; with an inquiry into the different theories of that disease. Lond Med J 1788; 9: 286–308.
-
von Mering J, Minkowski O.
Diabetes mellitus nach Pankreasextirpation. Arch Exp Pathol Pharmakol
1890; 26: 37.
10.1007/BF01831214 Google Scholar
-
Opie EL. On the relation of chronic interstitial pancreatitis to the islets of Langerhans and to diabetes mellitus. J Exp Med
1900; 5(4): 397–428.
10.1084/jem.5.4.397 Google Scholar
- Banting FG, Best CH. The internal secretion of the pancreas. J Lab Clin Invest 1922; 7(5): 251–266.
- Pollard H, Miller L, Brewer W. External secretion of the pancreas and diabetes (study of secretin test). Am J Dig Dis 1943; 10(1): 20–23.
- Vacca JB, Henke WJ, Knight WA. The exocrine pancreas in diabetes mellitus. Ann Intern Med 1964; 61: 242–247.
- Lanceraux E. Le diabete maigre: ses symptomes, son evolution, son pronostic et son traitement. Un Med Paris 1880; 20: 205–211.
- Falta W. Die Zuckerkrankheit. Berlin: Urban und Schwarzenberg, 1936.
-
Himsworth HP. Diabetes mellitus: its differentiation into insulin-sensitive and insulin-insensitive types. Lancet
1936; 227(5864): 127–130.
10.1016/S0140-6736(01)36134-2 Google Scholar
- Gepts W. Pathologic anatomie of the pancreas in juvenile diabetes. Diabetes 1965; 14: 619–633.
- Bottazzo GF, Florin-Christensen A, Doniach D. Islet cell antibodies in diabetes mellitus with autoimmune polyendocrine deficiencies. Lancet 1974; 304(7892): 1279–1283.
-
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care
1998; 21(Suppl 1): 5–19.
10.2337/diacare.21.1.S5 Google Scholar
- Hardt PD, Krauss A, Bretz L, et al. Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus. Acta Diabetol 2000; 37(3): 105–110.
- Hardt PD, Hauenschild A, Nalop J, et al. High prevalence of exocrine pancreatic insufficiency in diabetes mellitus. A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. Pancreatology 2003; 3(5): 395–402.
- Hardt PD, Hauenschild A, Jaeger C, et al. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Dig Dis Sci 2003; 48(9): 1688–1692.
- Cavalot F, Bonomo K, Fiora E, et al. Does pancreatic elastase-1 in stools predict steatorrhea in type 1 diabetes? Diabetes Care 2006; 29(3): 719–721.
- Hahn JU, Kerner W, Maisonneuve P, et al. Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas 2008; 36(3): 274–278.
- Mohapatra S, Majumder S, Smyrk TC, et al. Diabetes mellitus is associated with an exocrine pancreatopathy: conclusions from a review of literature. Pancreas 2016; 45(8): 1104–1110.
- Lazarus SS, Volk BW. Pancreas in maturity-onset diabetes. Pathogenetic considerations. Arch Pathol 1961; 71: 44–59.
- Lohr M, Kloppel G. Residual insulin positivity and pancreatic atrophy in relation to duration of chronic type 1 (insulin dependent) diabetes mellitus and microangiopathy. Diabetologia 1987; 30(10): 757–762.
- Garcia TS, Rech TH, Bauermann Leitao C. Pancreatic size and fat content in diabetes: a systematic review and meta-analysis of imaging studies. PLoS One 2017; 12: e0180911.
- Bolado F, Prieto C, Vila JJ, et al. Chronic pancreatitis-like changes detected by endoscopic ultrasound in type 1 diabetics are not associated with gastrointestinal symptoms or nutritional deficiencies. Pancreas 2017; 46(1): 102–105.
- Hardt P, Gammler D, Stracke H, et al. Correlation between exocrine pancreatic insufficiency as determined by fecal elastase 1 concentrations and neuropathy in patients with diabetes mellitus. Pancreatology 2011; 11: 146.
- Campbell-Thompson M, Rodriguez-Calvo T, Battaglia M. Abnormalities of the exocrine pancreas in type 1 diabetes. Curr Diab Rep 2015; 15(10): 79.
- Raeder H, Johansson S, Holm PI, et al. Mutations in the CEL VNTR cause a syndrome of diabetes and pancreatic exocrine dysfunction. Nat Genet 2006; 38(1): 54–62.
- Aida K, Fukui T, Jimbo E, et al. Distinct inflammatory changes of the pancreas of slowly progressive insulin-dependent (type 1) diabetes. Pancreas 2018; 47(9): 1101–1109.
- Kobayashi T, Nakanishi K, Kajio H, et al. Pancreatic cytokeratin: an antigen of pancreatic exocrine cell autoantibodies in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990; 33(6): 363–370.
- Hardt PD, Ewald N, Bröckling K, et al. Distinct autoantibodies against exocrine pancreatic antigens in European patients with type 1 diabetes mellitus and non-alcoholic chronic pancreatitis. JOP 2008; 9(6): 683–689.
- Ebert R, Creutzfeldt W. Reversal of impaired GIP and insulin secretion in patients with pancreatogenic steatorrhea following enzyme substitution. Diabetologia 1980; 19(3): 198–204.
- Beglinger S, Drewe J, Schirra J, et al. Role of fat hydrolysis in regulating glucagon-like Peptide-1 secretion. J Clin Endocrinol Metab 2010; 95(2): 879–886.
