Background: Previous studies suggested impaired pancreatic exocrine functio
n in type I diabetes patients, but have been limited by small or highly sel
ected samples. Fecal elastase-1 has facilitated evaluation of pancreatic dy
sfunction in population-based studies.
Methods: 112 type I diabetic patients (age SD: 37 +/- 11 years; 47% males;
diabetes duration: 12.5 +/- 10.5 years) were consecutively selected from ma
in regional diabetes centers in Essen, West-Germany. 116 non-diabetic contr
ol subjects, similar with respect to age and sex, were recruited from the s
ame geographical region. Elastase-1 measurement was performed centrally by
ELISA (ScheboTech, Germany).
Results: Elastase-1 concentrations in type I diabetic patients were signifi
cantly lower than in control subjects (median; inter-quartile range: diabet
ic patients: 227, 98-386 mug/g stool; non-diabetic subjects: 544, 377-702 m
ug/g stool) (p < 0.01). Elastase-1 < 100 mug/g stool (El < 100) was found i
n 25.9% of diabetic and 5.2% of non-diabetic subjects, yielding an age-sex-
adjusted prevalence Odds ratio (POR; 95% CI) for diabetes and El <less than
> 100 of 6.9 (2.8-19.6). After adjusting for potential confounders (history
of gastrointestinal diseases, smoking, alcohol consumption) the strong ass
ociation remained (POR: 6.7; 2.7-19.2). Among patients with diabetes, El <
100 was associated with quality of glycemic control (HbA1c, change per 1%:
POR 1.5; 1.1-2.0), diabetes duration (per year: POR 1.1; 1.03-1.2), and age
at diabetes onset (per age year: POR 1.1; 1.02-1.1). No association was fo
und with history of gastrointestinal diseases, smoking, or alcohol consumpt
ion (current, life-time).
Conclusions: Fecal elastase-1 concentrations were lower in type I diabetes
patients compared to control subjects, indicating impaired pancreatic exocr
ine function. Low elastase-1 was associated with poor metabolic control and
longer diabetes duration.