Evaluation of the frequency of exocrine pancreatic insufficiency in patients with diabetes mellitus

Introduction and Aim: In our study, the frequency of exocrine pancreatic insufficiency,and its relationship with the duration of diabetes and the level of glycemic control and other complications of diabetes were investigated in patients with diabetes mellitus. Materials and Methods: A total of 249 diabetic patients, 21 with type 1 diabetes mellitus, 2 with MODY, and the remaining 226 with type 2 diabetes mellitus, were included in this prospective study, between 15 September 2021 and 20 September 2022. The frequency of exocrine pancreatic insufficiency was investigated using fecal elastase-1 measurements in stool. Statistical evaluations were made with T test, Chi-square test and Kruskal Wallis test. Results: In 20 patients, fecal elastase-1 levels were below 100 mcg/mL and this was considered as severe exocrine pancreatic insufficiency. In 57 patients, fecal elastase-1 levels were found to be between 100-200 mcg/mL and it is evaluated as mild-moderate exocrine pancreatic insufficiency. In total, exocrine pancreatic insufficiency was detected in 77 patients (30.9%). While mean duration of diabetes mellitus in 77 patients with exocrine pancreatic insufficiency was 11.34±9.42 years, the mean disease duration of 172 patients with normal fecal elastase levels was 9.06±7.81 years. The difference was found to be statistically significant (p=0.047). When glycemic control, duration of diabetes mellitus and exocrine pancreatic insufficiency were evaluated, exocrine pancreatic insufficiency was found more frequently in patients with HbA1c level above 8.5% (p=0.007) and in patients with diabetes mellitus for more than 15 years (p=0.018). In addition, when diabetes mellitus complications and exocrine pancreatic insufficiency were evaluated, exocrine pancreatic insufficiency was found more frequently in patients with diabetic retinopathy (p=0.033). No relation was found between neuropathy, nephropathy and coronary artery disease. Conclusion: In our study, it was revealed that exocrine pancreatic insufficiency was more common as the duration of diabetes increased and glycemic control worsened. Exocrine pancreatic insufficiency was also found more frequently in patients with diabetic retinopathy. Although it is thought that exocrine pancreatic insufficiency may be one of the chronic complications of diabetes mellitus, further studies with more patients are needed.