Department of Gastroenterology, Tallaght University Hospital, TallaghtDublin 24, Ireland.
Department of Gastroenterology, Letterkenny University Hospital, Letterkenny, Ireland.
Acta Diabetol. 2024 Oct;61(10):1301-1307. doi: 10.1007/s00592-024-02307-z. Epub 2024 May 26.
Type 1 and type 2 diabetes mellitus (DM) are often accompanied by mild forms of pancreatic exocrine insufficiency (PEI). The prevalence rates of PEI in diabetic patients are unclear and variable depending on the testing modality and the studies published. The clinical consequences of PEI in diabetics are also not well defined.
We aimed to determine the prevalence of PEI in a diabetic cohort using the faecal elastase-1 (FE-1) assay as a screening test and to validate a patient-reported symptom-based scoring system, the (PEI-S) for diagnosing PEI within this patient population.
Two hundred and three diabetic patients attending diabetic and gastroenterology outpatients of a university hospital without previously known PEI were recruited for the study. Demographic parameters, PEI score (PEI-S), and glycated hemoglobin (HBA1c) were documented in standardized data sheets, and a stool sample was obtained. A FE-1 value < 200 μg/g and or a PEIS of > 0.6 was used as the screening cut-off for PEI.
One hundred sixty-six patients returned faecal samples. The prevalence of PEI, as measured by low FE-1, was 12%. Smoking was associated with an increased risk of developing PEI in this diabetic population. No other independent risk factors were identified. The PEI-S system did not differentiate between people with diabetes having a normal and low FE1.
12% of this mixed, real-life cohort of type 1 and 2 DM patients had undiagnosed PEI, as defined by an FE-1 score of less than 200 μg/g. While this may appear low, given the rising prevalence of type 2 DM worldwide, there is likely an unrecognized burden of PEI, which has long-term health consequences for those affected. The PEI-S, a symptom-scoring system for patients with PEI, did not perform well in this patient group.
1 型和 2 型糖尿病（DM）常伴有轻度胰腺外分泌不足（PEI）。患有糖尿病的患者中 PEI 的患病率尚不清楚，且因检测方式和已发表的研究而有所不同。PEI 对糖尿病患者的临床影响也尚未明确。
我们旨在使用粪便弹性蛋白酶-1（FE-1）检测作为筛查试验，来确定糖尿病患者队列中 PEI 的患病率，并在该患者人群中验证一种基于患者报告症状的评分系统（PEI-S），以用于诊断 PEI。
我们招募了 203 名在大学医院的糖尿病和胃肠病门诊就诊、且无已知 PEI 的糖尿病患者参与研究。在标准化数据表中记录了人口统计学参数、PEI 评分（PEI-S）和糖化血红蛋白（HBA1c），并获取了粪便样本。FE-1 值<200μg/g 和/或 PEI-S>0.6 被用作 PEI 的筛查截断值。
166 名患者返回了粪便样本。通过低 FE-1 检测，PEI 的患病率为 12%。在该糖尿病人群中，吸烟与发生 PEI 的风险增加相关。未发现其他独立的危险因素。PEI-S 系统无法区分糖尿病患者中 FE1 正常和低的人群。
在我们的 1 型和 2 型 DM 混合真实队列中，有 12%的患者患有未确诊的 PEI，其定义为 FE-1 评分<200μg/g。虽然这似乎较低，但鉴于全球 2 型糖尿病的患病率不断上升，PEI 可能未被识别，这对受影响的人有长期的健康影响。PEI-S 是一种用于 PEI 患者的症状评分系统，在该患者组中的表现不佳。
