Patients With Type 1 Diabetes Have Markers of Exocrine Pancreatic Impairment

Male pancreas, illustration.
Pancreatic exocrine function has long been suspected of playing a role in type 1 diabetes.

Patients with type 1 diabetes (T1D) were observed to have exocrine pancreatic impairment associated with reduced nutritional indexes which deteriorated with T1D disease duration. These findings, from a cross-sectional study, were published in BMJ Open Diabetes Research and Care.

“Our findings confirm the evidence of some degree of impairment of the pancreatic exocrine function in patients with T1D, compared with healthy controls. Lipase activity was reduced as a non-significant trend when measured by the 13C-mixed triglyceride breath test, while functional insufficiency was more manifest and significant when reflected by the reduction of fecal elastase-1 and serum pancreatic amylase and lipase,” wrote authors who were led by Emanuele Bosi, PhD, of Vita-Salute San Raffaele University, Milan, Italy.

Patients (n=31) with T1D and healthy controls (n=25) were recruited at the San Raffaele Hospital in Italy. Participants were assessed for C-peptide from blood, urine, and breath, serum was tested for multiple nutritional markers, pancreatic amylase, and lipase, and feces was analyzed for elastase-1.

Patients with T1D had long-standing diagnoses (n=19) or were newly diagnosed (n=12). These patient groups differed significantly by age of T1D onset (median, 14 vs 25 years; P =.0035) and disease duration (median, 13.5 years vs 36 days; P <.0001), respectively. Compared with controls, the patient groups had significantly lower BMI (P =.0166) and fasting C-peptide (P =.0001) and had significantly higher plasma glucose (P =.0001) and glycated hemoglobin (P <.0001).

The pancreatic exocrine functional assay indicated patients with long-standing T1D had the lowest median fecal elastase, pancreatic amylase, lipase, retinol binding protein, and prealbumin concentrations. All markers were significantly different from controls (all P ≤.0019). Compared with new-onset T1D, all markers were significantly lower among the long-standing T1D group (all P ≤.037) except fecal elastase (P =.199). No markers, except fecal elastase (P =.0070), differed significantly between controls and new-onset T1D (all P ≥.4062).

Reductions of serum pancreatic amylase, lipase, and fecal elastase-1 correlated with fasting and urinary C-peptide concentrations (all P <.001) but not with lipase activity. Urinary C-peptide and serum fasting correlated with retinol binding protein and prealbumin (all P <.001).

This study was limited by its low sample sizes. The investigators were not approved for the recruitment of children or adolescents into this study, so, it remains unclear whether or not prediabetic children exhibited signs of pancreatic impairment.

The study authors concluded impaired exocrine pancreatic function was a feature of T1D. This condition was most marked by low serum pancreatic amylase and lipase with low fecal elastase-1. These features appeared to progress over time as newly diagnosed patients had more similar levels as controls than patients who were diagnosed for more than 10 years previously.


Dozio N, Indirli R, Giamporcaro G M, et al. Impaired exocrine pancreatic function in different stages of type 1 diabetes. BMJ Open Diabetes Res Care. 2021;9(1):e001158. doi:10.1136/bmjdrc-2019-001158.