Relationship between pancreas exocrine insufficiency and cardiac autonomic neuropathy in patients with diabetes mellitus

Background: Autonomic neuropathy is a serious complication of diabetes mellitus (DM). It is likely that pancreatic exocrine insufficiency (PEI) is responsible for gastrointestinal symptoms in diabetic patients. Diabetic autonomic neuropathy can disrupt enteropancreatic reflexes and cause PEI. The relationship between cardiac autonomic neuropathy (CAN), which is a distinct type of diabetic autonomic neuropathy, and PEI is unknown. The aim of present study is to evaluate the association of PEI and CAN. Materials and Methods: Total of 110 DM patients who applied to the Gaziantep University Şahinbey Training and Research Hospital Endocrinology and Metabolic Diseases, Gastroenterology and Geriatrics Polyclinic with persistant gastrointestinal complaints and 17 years or older were included in the study. As control group, 40 healthy persons were included in the study. Type of DM, age, disease age, body mass index, complaint, presence of hypoglycemia, usage of insulin pump, c-peptide, insulin, LDL cholesterol, HbA1C and D vitamine level, hepatosteatosis presence and complications were recorded for each patients. CAN tests were applied using Ewing and Clarke's criteria and the severity of cardiac dysfunction was determined. 100 mg of gaita samples were taken from the partipicants for fecal elastase-1 (FE-1) measurement. Result: The mean FE-1 levels were 179,67±74,95 μg/gram and 262,40±94,98 μg/gram in the patient and control group, respectively. PEI was detected in 67 (69.1%) patients and 3 (7.5%) healthy subjects. Seventy two patients (65.5%) had cardiac disotonomy and other 38 (34.5%) did not have. Cardiac disotonomy was not detected in the control group. There was a significant difference between patient and control group in terms of FE-1 levels and CAN (p=0.001 for both). Significant correlation was also found between cardiac disotonomy grade and FE-1 level (p=0.001). Conclusion: Our study showed that there is a relationship between CAN and PEI and that they can be seen together. We believe that the coexistence of these two conditions may affect diabetic patient's quality of life and life span negatively. We believe that diabetic autonomic neuropathy may develop in patients with persistant gastrointestinal complaints, PEI can be added to this clinical picture and it can be observed with CAN, and that the treatment planning of patients should be done accordingly.