Diabetes mellitus refers to a group of diseases that cause high blood sugar levels. The most common type is type 2 diabetes, which is caused by insulin resistance and inadequate insulin production. However, diabetes can also result from conditions affecting the exocrine pancreas. Both type 1 and type 2 diabetes patients may experience changes in their pancreatic exocrine function, leading to reduced levels of fecal elastase-1 in many cases. This review paper focuses on the role of specific pancreatic biomarkers in diabetes mellitus, including cholecystokinin, trypsin, chymotrypsin, carboxypeptidase, amylase, lipase, secretin, elastase-1, and retinol-binding protein 4 about recent advances and discoveries, significant gaps in the literature, current debates, and potential directions for future research related to these biomarkers about diabetes mellitus. This review article discusses various biomarkers related to pancreatic exocrine and endocrine function and their implications in diabetes. It suggests that gut cholecystokinin may play a role in lowering glucose synthesis through a neural network and resistance to it could contribute to hyperglycemia in diabetic patients. It also discusses the use of various markers such as serum trypsin concentration, amylase and lipase levels, pancreatic elastase levels, and fasting secretin levels to assess pancreatic exocrine function. Additionally, the article explores the role of carboxypeptidase E in the endocrine and neurological systems and its association with disorders. Moreover, it also highlights the involvement of retinol-binding protein 4 in the development of type 2 diabetes and insulin resistance.