There is increasing evidence that exocrine pancreatic function may be impaired in patients with type 1 diabetes (1,2). Cavalot et al. (3) found that fecal pancreatic elastase-1 (PE-1) was significantly lower in 37 consecutive type 1 diabetic subjects than in 20 healthy control subjects. PE-1 values were directly correlated to C-peptide values and inversely correlated to HbA1c (A1C) and diabetes duration. No correlation between BMI and PE-1 was found. The authors therefore concluded that both residual insulin secretion and glycemic control have relevant effects on exocrine pancreatic function in type 1 diabetic patients.
In contrast to these findings, we found no association between PE-1 values and A1C in our study population. Sixteen consecutive patients with type 1 diabetes (9 men and 7 women) followed at our unit were studied (age 30.8 ± 6.8 years, BMI 24.1 ± 3.5 kg/m2, duration of diabetes 14.3 ± 10.6 years, A1C 7.7 ± 1.2% [means ± SD]). In addition, 16 age-, sex-, and BMI-matched healthy control subjects were examined. PE-1 concentrations in stools were determined by enzyme-linked immunosorbent assay (intra-assay variance 5.8%, interassay variance 7.7%; ScheBo-Tech). PE-1 concentrations >200 μg/g stools indicate normal exocrine pancreatic function, concentrations between 100 and 200 μg/g indicate mild exocrine pancreatic insufficiency, and concentrations <100 μg/g indicate severe exocrine pancreatic insufficiency.
The PE-1 concentrations of patients with type 1 diabetes were significantly reduced compared with control subjects (244.1 ± 192.6 vs. 515.1 ± 174.2 μg/g stools, P < 0.003). Six patients (four men and two women) had PE-1 concentrations between 100 and 200 μg/g stools, three patients (one man and two women) had PE-1 levels <100 μg/g stools, and one patient had PE-1 levels <200 μg/g stools. In diabetic patients, there were no correlations between PE-1-values and diabetes duration (r = 0.07, P = 0.79), age (r = − 0.20, P = 0.47), A1C (r = −0.26, P = 0.32), or BMI (r = 0.27, P = 0.30). In patients with A1C >8% (n = 5), PE-1 did not differ from those with A1C ≤8% (n = 11) (214.6 ± 263.6 vs. 257.4 ± 165.1 μg/g stools, P = 0.69). Among patients with A1C >8%, 4 of 5 patients had PE-1 concentrations <200 μg/g stools compared with 5 of 11 with A1C <8% (P = 0.59).
The main finding of our study is that PE-1 is significantly lower in type 1 diabetic subjects and confirms the frequent occurrence of an exocrine pancreas deficiency in these patients. These results are consistent with those of Cavalot et al.; however, we did not find any association between PE-1 values and A1C and diabetes duration. There is no mention of comedication with antihypertensive agents or other medications in the Cavalot et al. study. Recent data demonstrate the existence of an islet angiotensin-generating system of potential importance on exocrine pancreatic function (4). Therefore, antihypertensive agents interfering with the angiotensin system could influence exocrine pancreatic function (5). In our study, 5 of 16 patients were treated with antihypertensive agents (ACE inhibitors in 4 and an angiotensin II receptor blocker in 1). These five subjects had lower PE-1 values than patients without such treatment (121.1 ± 83.3 vs. 299.9 ± 204 μg/g stools), although the difference was not statistically significant (P = 0.088).
