Diabetes Mellitus Is Associated With an Exocrine Pancreatopathy

Abstract

Objective Abnormalities in exocrine pancreatic function have been reported in diabetes mellitus (DM). We reviewed published literature to determine the nature of structural and functional alterations in the exocrine pancreas in DM. Methods We identified and abstracted data from original studies (n = 50) describing morphological, structural, and functional changes in the exocrine pancreas in types 1 and 2 DM. Results Pancreatic weight and volume are markedly lower in type 1 DM (P < 0.005) with insignificant decrease in type 2 DM compared with age-, sex-, and body mass index–matched controls. Pancreatic histopathological changes seen in most subjects with DM at autopsy (n = 7 studies, 1272 autopsies) include mild-to-marked interacinar fibrosis, scant inflammatory infiltrate, no pancreatic ductal changes, and hyalinization of arteries. In subjects with DM, pooled prevalence of decreased fecal elastase 1 (<200 μg/g) is higher, coefficient of fat absorption is near normal (mean, 91%–94%), and pancreatic exocrine dysfunction is nonprogressive over time. Diabetes mellitus is asymptomatic in regard to the exocrine pancreas. Conclusions In types 1 and 2 DM, moderate-to-severe subclinical pancreatic fibrosis and modest exocrine dysfunction occurs in the absence of clinical or histopathological evidence of chronic pancreatitis. We call this novel entity “diabetic exocrine pancreatopathy.”

Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer

“…The largest study to assess prevalence among a cohort with diabetes classified 172 (9.2%) of 1868 as having type 3c diabetes. 3 However, several factors are likely to have inflated this prevalence, including unresolved questions regarding whether or not the test abnormalities observed (eg, decreased faecal elastase-1 value) are a consequence of a disease of the exocrine pancreas or a secondary effect of diabetes (recently termed diabetic exocrine pancreatopathy 7 ). A smaller study in 150 participants with diabetes reported a 5.4% prevalence of type 3c diabetes.…”

Chronic pancreatitis

“…Furthermore, certain groups—older people, those with longstanding diabetes, people who drink alcohol moderately, and those who smoke—can develop changes in the pancreas (radiological and histological) that mimic the features of chronic pancreatitis. This pancreatic damage has been termed “pancreatopathy,” to distinguish it from chronic pancreatitis 15. Later in the clinical course of chronic pancreatitis, imaging tests become more reliable diagnostic tools 1416…”

Managing Chronic Pancreatitis: The View from Medical Pancreatology

“…In a subset of patients with convincing history but normal cross-sectional studies, we perform an endoscopic ultrasound (EUS) to further assess for morphological changes. We are cognizant that a normal or minimally abnormal EUS does not exclude or diagnose CP, and the confounding effect of several factors (e.g., age, alcohol, tobacco, and diabetes) on parenchymal and ductal changes must also be considered [2, 3]. We do not routinely use secretinstimulated pancreatic function testing in clinical practice, as its positive predictive value is suboptimal [4], and may not affect decision making.…”