Diabetes Has Minimal Effect On High Gastrointestinal Symptom Burden in Exocrine Pancreatic Insufficiency Based On EPI/PEI-SS Scores

Abstract

Background: Exocrine pancreatic insufficiency (EPI or PEI) may be prevalent in as many as 3 of 10 people with diabetes, due to exocrine pancreatic function reduced as early as the time of diagnosis. EPI can be treated with pancreatic enzyme replacement therapy (PERT), but the symptom burden of EPI remains high and improved screening and diagnosis methods are needed.Methods: An online survey (n=324) evaluated the gastrointestinal symptom experiences of people with (n=155) and without (n=169) EPI using a novel symptom tool, the Exocrine Pancreatic Insufficiency Symptom Score (EPI/PEI-SS). A large subgroup (n=120) of people with diabetes, with EPI (Type 1, n=14, Type 2, n=20) or without EPI (Type 1, n=78; Type 2; n=6) was characterized and compared to those without diabetes (n=204) in a sub-analysis of the larger EPI/PEI-SS study.Results: The symptom burden of EPI is similar, irrespective of diabetes. Like those without diabetes, people with type 1 diabetes had a statistically significant (p<0.001) higher mean score (range 0-225) with the EPI/PEI-SS (100.86, SD: 48.92) than did people with T1D without EPI (31.59, SD: 28.25), distinct from other GI conditions (p<0.001). Similar patterns occurred in those with T2D. Conclusion: High EPI/PEI-SS scores seem to distinguish between likely EPI and other GI conditions among people with diabetes, and it should be further studied as a possible screening method for EPI at a population level. It should also be evaluated as a tool to aid individuals with diabetes in tracking changes to EPI symptoms over time based on PERT titration.