The easy way of evaluating exocrine pancreatic insufficiency in type 2 diabetes : listen to the patients’ complaints and look in their eyes!

Background and study aims: The objective of this study is to determine the prevalence of exocrine pancreatic insufficiency (EPI) in diabetic patients, and to investigate whether there is a relationship between EPI and diabetes period, gastrointestinal complaints and other diabetic microvascular complications.

Patients and methods: A total of 93 participants, consisting of 57 type 2 diabetes patients and 36 healthy volunteers have been included in our cross-sectional study. Participants were questioned for abdominal complaints and weight loss. Fecal elastase-1 (FE-1) was determined in fecal spot samples received from participants. The relationship between EPI and blood glucose, HbA1c, and duration and complications of diabetes were investigated.

Results: FE-1 levels were significantly lower in diabetic group compared to control group (p=0.007). The number of patients with FE-1 levels of <200μg/g were significantly higher in diabetic group (p=0.002). A statistically significant negative correlation was determined between FE-1 levels and the duration of diabetes (r= -0.453 p<0.001). FE-1 levels were significantly lower in patients with retinopathy (p= 0.014). In the post-hoc analysis, this difference was due to patients in the proliferative retinopathy group. A significant negative correlation was determined between the presence of retinopathy and FE-1 levels (r=-0.32, p=0.02). Abdominal pain and distension complaints were independent predictive factors that estimate EPI.

Conclusions: An important part of type 2 diabetes patients has EPI and it should be considered in diabetes patients upon abdominal pain and distension. Determination of proliferative retinopathy in the eye examination may also suggest an idea on the possible presence of EPI.

Keywords: exocrine pancreatic insufficiency, abdominal distention, abdominal pain, diabetic retinopathy.