Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus

Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we inve stigated exocrine pancreatic function in 105 controls and 114 patients with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal el astase-l concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold stand ard. Reduced faecal elastase-l concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-l con centrations did not correlate with alcohol consumption, diabetes duration o r diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exo crine pancreatic function is also impaired in a high percentage in this gro up of patients. Pathogenetic concepts to explain these findings as conseque nces of diabetes complications or insulin deficiency are still under debate . Observations from autopsies and the data of the controls in this study su ggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than bel ieved so far.