Z Gastroenterol 2010; 48 - A96
DOI: 10.1055/s-0030-1254834

Assessment of the exocrine pancreatic dysfunction and the effects of enzyme substitution in patients with non-pancreatic diabetes

T Várkonyi 1, A Szabolcs 1, V Szidor 1, A Szász 1, R Laurentzi 1, A Orosz 2, C Lengyel 1, P Kempler 3, T Takács 1, T Wittmann 1
  • 11st Dept. of Internal Medicine, University of Szeged
  • 2Dept. of Pharmacology and Pharmacotherapy, University of Szeged
  • 31st. Dept. of Internal Medicine, Semmelweis University, Budapest

The consequences of the exocrine pancreatic insufficiency are well-known in pancreatic diabetes (DM). Aim: The aim of this study was to determine the frequency of low stool elastase activity in type-1 and type-2 DM patients (pts). The metabolic parameters and the chronic complications were evaluated in pts with normal and abnormal exocrine function and the effects of enzyme substitution were analysed. Patients and Methods: Stool elastase of 146 pts with non-pancreatic DM was measured by ELISA. Autonomic neuropathy (AN), peripheral sensory function, retinopathy, HbA1c, BMI, microalbuminuria (MAU), quality of life (QoL) were measured. Results: 41 pts (28%) had an affected exocrine function (elastase: 417±37 vs. 141±11 ug/g; mean of pts with normal vs. abnormal values, p<0.001). 37 pts had a moderately lower level (in the range from 100 to 200 ug/g), while 4 pts had severe dysfunction (<100 ug/g). The frequency of type-1 and type-2 DM was similar in pts with low elastase (46 vs. 54%, type-1 vs. type-2 DM). The duration, age, BMI, HbA1c, MAU, QoL and retinopathy did not differ significantly between the groups with normal and abnormal elastase. A tendency of more severe AN and sensory neuropathy was observed in pts with lower elastase. A negative correlation was found between age and elastase pointing to more abnormal values in older pts (r=–0.60, p<0.001). In 25 pts of the enzyme substitution study non-significant tendencies were detected in several parameters by the end of the follow-up: HbA1c decreased from 8.17±0.38% to 7.98±0.44%, while fasting glucose changed from 9.97±1.22mmol/l to 7.69±0.91mmol/l (p>0.05). The severity of AN decreased (AN score: from 3.09±0.61 to 2.36±0.66, p>0.05). Conclusions: A moderately impaired exocrine pancreatic function is a characteristic finding in a high number of patients with both types of diabetes. This altered function is more severe in older patients. The enzyme substitution might have an important role in the treatment of diabetic patients with higher age, severe neuropathy and unstable glycemic control.