Longitudinal assessment of pancreatic exocrine dysfunction in type 1 diabetes

Previous studies have shown that individuals with type 1 diabetes (T1D) frequently present with reduced fecal elastase levels, suggesting exocrine pancreatic insufficiency. However, the underlying determinants and the longitudinal trajectory of these changes remain poorly understood.

To evaluate longitudinal changes in fecal elastase among individuals with T1D, identify associated factors, and determine clinical implications.

Pancreatic exocrine function was evaluated in a cohort of patients with T1D by measuring fecal elastase concentrations (FECs). After a mean follow-up of 8.5 ± 0.5 years, participants were recontacted, and a second stool sample was obtained. At both time points, detailed medical histories were collected, including information on diabetes progression, metabolic control, complications, gastrointestinal symptoms, and nutritional status. The study was approved by the institutional ethics committee, and written informed consent was obtained from all participants.

A total of 106 individuals with T1D (mean age = 46.2 years; 50% male) were enrolled. At baseline, the median FEC was 239.5 µg/g, with 44 participants (41.5%) demonstrating abnormally low levels (< 200 µg/g). Reduced fecal elastase was significantly associated with male sex, diabetes-related complications, particularly retinopathy, and higher glycated hemoglobin levels. No significant differences in gastrointestinal symptoms, body mass index, nor most serum nutritional markers were observed between individuals with normal vs reduced fecal elastase levels. Sixty-six participants completed follow-up. Their median fecal elastase was 171.5 µg/g, with 59.1% presenting levels below 200 µg/g. Paired analysis showed a non-significant decline in FEC s over time. No clinical nor metabolic variables predicted longitudinal changes in FEC independently.

Fecal elastase levels are frequently reduced in individuals with T1D and may show a gradual decline over time. The clinical impact of these changes appears to be limited.