Exocrine pancreatic insufficiency in type 1 and type 2 diabetesmellitus: do we need to treat it? A systematic review

Abstract

The exocrine and endocrine pancreata are very closely linked both anatomically and physiologically. Abdominal symptoms such as nausea, bloating, diarrhea, steatorrhea, and weight loss can often occur in diabetic patients. Impairments of the exocrine pancreatic function seem to be a frequent complication of diabetes mellitus; however, they are largely overlooked. The aim of this paper is to provide an overview of the current concepts of exocrine pancreatic insufficiency (PEI) in diabetes mellitus. This systematic review provides information on the high prevalence of chronic pancreatic diseases in patients with diabetes; statements that reveal the multifactorial mechanism of PEI development upon violation of glucose uptake are summarized. The main PEI clinical manifestations in diabetes are described, the difficulties of timely detection of EPN are considered, the advantages and disadvantages of the “gold standards” of laboratory diagnostics (determination of the level of fecal elastase 1 and the coefficient of fat absorption, respiratory test using mixed triglycerides, 13C labeled, and secretin-pancreozymin test) in this cohort of patients. The data of randomized researches that studied the effectiveness of enzyme replacement therapy of PEI in patients with diabetes are analyzed. The ability of enzyme replacement therapy to normalize digestion has been confirmed, and its possible effect on glycemia and vitamin D levels in patients with diabetes and EPN has been considered. The reasons for the continuation of taking enzyme preparations are listed.