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Cells and Secretions of the Pancreas01:16

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Updated: Nov 20, 2025

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Exocrine Pancreas Dysfunction in Type 1 Diabetes.

Timothy P Foster1, Brittany Bruggeman1, Martha Campbell-Thompson2

  • 1From the (1)Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, and.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|January 20, 2021
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Type 1 diabetes (T1D) is linked to exocrine pancreas damage, with higher rates of pancreatic exocrine insufficiency (PEI) than controls. Pancreatic enzyme replacement therapy (PERT) may benefit symptomatic T1D patients with PEI.

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Area of Science:

  • Endocrinology and Metabolism
  • Gastroenterology
  • Immunology

Background:

  • Type 1 diabetes (T1D) involves autoimmune destruction of pancreatic beta cells.
  • Exocrine pancreas abnormalities may also contribute to T1D pathophysiology.
  • Evidence suggests a role for exocrine dysfunction in T1D.

Purpose of the Study:

  • To review current evidence of exocrine damage in T1D.
  • To discuss the pathophysiology, clinical evaluation, and treatment of exocrine dysfunction in T1D.
  • To highlight the clinical relevance and management of pancreatic exocrine insufficiency (PEI) in T1D.

Main Methods:

  • Conducted an extensive literature search using keywords 'type 1 diabetes' and 'exocrine dysfunction'.
  • Searched databases including PubMed and Google Scholar for relevant studies.
  • Synthesized findings on exocrine pancreas abnormalities in T1D.

Main Results:

  • T1D pancreata show reduced weight and volume compared to controls.
  • Histological examination reveals immune cell infiltration, fibrosis, arteriosclerosis, fatty infiltration, and acinar atrophy in T1D exocrine tissues.
  • Prevalence of PEI in T1D is consistently higher than in controls, assessed via direct testing, fecal elastase concentration (FEC), and serum enzyme levels.

Conclusions:

  • Exocrine pancreas abnormalities are common in T1D, though the precise timing relative to beta-cell destruction is unclear.
  • PEI evaluation, typically with FEC, is recommended for T1D patients experiencing gastrointestinal complaints.
  • Pancreatic enzyme replacement therapy (PERT) is advised for symptomatic T1D patients with confirmed PEI, potentially improving symptoms, quality of life, glycemic control, and nutrition.