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Changes in pancreatic exocrine function in young at-risk children followed to islet autoimmunity and type 1 diabetes

Megan A S Penno1, Helena Oakey1, Priya Augustine2

  • 1Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.

Pediatric Diabetes
|May 21, 2020
PubMed

Insights

Pancreatic exocrine function declines in children at risk for type 1 diabetes who develop islet autoimmunity. This decline in fecal elastase-1 (FE-1) can precede the onset of islet autoimmunity (IA) and type 1 diabetes (T1D).

Area of Science:

  • Pediatrics
  • Endocrinology
  • Immunology

Background:

  • Type 1 diabetes (T1D) development involves islet autoimmunity (IA).
  • Pancreatic exocrine function in at-risk children is not well understood in relation to T1D progression.
  • The Environmental Determinants of Islet Autoimmunity (ENDIA) study prospectively follows at-risk children.

Purpose of the Study:

  • To longitudinally monitor pancreatic exocrine function in children at risk for T1D.
  • To assess the relationship between exocrine function and the development of IA and T1D.
  • To identify early markers of T1D development.

Main Methods:

  • Fecal elastase-1 (FE-1) concentration was measured longitudinally in 85 at-risk children.
  • Children were categorized as progressors (developed IA) or non-progressors (remained IA-negative).
  • An adjusted linear mixed model compared FE-1 concentrations between groups.

Main Results:

  • Baseline FE-1 did not differ between progressors and non-progressors.
  • FE-1 concentration decreased over time in progressors compared to non-progressors (P = .02).
  • In some progressors, the fall in FE-1 preceded the onset of IA.

Conclusions:

  • Pancreatic exocrine function decreases in most young children who progress to IA and T1D.
  • Reduced FE-1 may serve as an early indicator of T1D development in at-risk children.
  • Longitudinal monitoring of pancreatic exocrine function is valuable in T1D research.
Abstract

Keywords:
childrenexocrine pancreasfecal elastaseislet autoimmunitytype 1 diabetes

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