Service de Diabétologie, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France.
INSERM U 1016, Département Hospitalo Universitaire «AUTHORS», Université Paris Descartes, Paris, France.
Acta Diabetol. 2019 Jun;56(6):651-658. doi: 10.1007/s00592-019-01294-w. Epub 2019 Feb 10.
Altered pancreatic exocrine function can be observed in patients with type 1 or type 2 diabetes. In the present study, we evaluated the potential nutritional consequences of this dysfunction.
Serum concentrations of nutritional markers, including albumin, cholesterol, triacylglycerol, vitamins A, D, and E, were assessed in a cohort of 468 patients (137 with type 1 diabetes and 331 with type 2 diabetes), after exclusion of the patients with a CRP > 10 mg/l. These patients were compared with 47 patients with diseases of the exocrine pancreas and diabetes (type 3c diabetes or pancreatogenic diabetes). Fecal elastase-1 and chymotrypsin concentrations were measured and patients with type 1 and type 2 diabetes were divided into three groups according to whether zero (group NN), one (group LN), or both (group LL) concentrations were decreased.
Several markers differed significantly between the groups of patients, including BMI, albumin, phosphorus, and fat-soluble vitamins. Patients with pancreatogenic diabetes had markedly more profound alterations than patients with type 1 or type 2 diabetes and altered exocrine function. However, patients with type 1 or type 2 diabetes and decreased concentrations of both elastase-1 and chymotrypsin had lower albumin, phosphorus, and vitamin A than patients with normal pancreatic exocrine function.
Modest nutritional alterations were found in patients with type 1 or type 2 diabetes and altered exocrine function. Patients with type 1 or type 2 diabetes and altered exocrine function may thus deserve to be screened for nutritional deficiencies.
1 型或 2 型糖尿病患者可出现胰腺外分泌功能改变。本研究旨在评估该功能障碍的潜在营养后果。
排除 C 反应蛋白（CRP）＞10mg/L 的患者后，评估了 468 例患者（137 例 1 型糖尿病患者和 331 例 2 型糖尿病患者）的营养标志物（包括白蛋白、胆固醇、三酰甘油、维生素 A、D 和 E）血清浓度。将这些患者与 47 例胰腺外分泌疾病合并糖尿病（3c 型糖尿病或胰源性糖尿病）患者进行比较。检测粪便弹性蛋白酶-1 和糜蛋白酶浓度，并根据是否有 1 项（组 LN）或 2 项（组 LL）浓度降低将 1 型和 2 型糖尿病患者分为 3 组。
各组患者的多项标志物存在显著差异，包括 BMI、白蛋白、磷和脂溶性维生素。与 1 型或 2 型糖尿病患者相比，胰源性糖尿病患者的改变更为显著，且胰腺外分泌功能也发生了改变。然而，与具有正常胰腺外分泌功能的患者相比，1 型或 2 型糖尿病且弹性蛋白酶-1和糜蛋白酶浓度均降低的患者的白蛋白、磷和维生素 A 水平更低。
在胰腺外分泌功能改变的 1 型或 2 型糖尿病患者中发现了轻微的营养改变。因此，可能需要对胰腺外分泌功能改变的 1 型或 2 型糖尿病患者进行营养缺乏筛查。
