High prevalence of exocrine pancreatic insufficiency in diabetes mellitus. A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients

Pancreatology. 2003;3(5):395-402. doi: 10.1159/000073655. Epub 2003 Sep 24.


Background: There have been numerous reports on pancreatic exocrine dysfunction in diabetes mellitus using either direct or indirect function tests. The measurement of fecal elastase 1 concentrations (FEC) has been used as a screening tool for exocrine pancreatic disease in different patient groups indicating a high prevalence of exocrine dysfunction in diabetic populations. In this study we had the opportunity to study more than 1,000 diabetic patients to confirm recent observations in smaller populations.

Methods: FEC were measured by ELISA in 323 patients with type 1 and 697 type 2 diabetes mellitus. Subjects with a history of alcohol abuse, gastrointestinal surgery, cancer or inflammatory diseases were not included. Diabetes history and clinical data were recorded using a standard case report form.

Findings: 1,021 patients (334 female, 687 male; mean age 50 years; mean diabetes duration 11 years; mean age at onset of diabetes 39 years) were studied. FEC was normal (>200 microg/g) in 59.3% and severely reduced (<100 microg/g) in 22.9%. There were significant differences between type 1 and type 2 patients as well as between insulin-treated and non-insulin-treated patients. Furthermore, there were weak associations between FEC and diabetes duration, age at onset of diabetes and body mass index, respectively.

Interpretation: We could confirm that both type 1 and type 2 diabetic patients show pathological exocrine function in high prevalence. Exocrine insufficiency seems to be correlated to early onset of endocrine failure, long-lasting diabetes mellitus and low body mass index levels.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Diabetes Complications*
  • Diabetes Mellitus / enzymology*
  • Enzyme-Linked Immunosorbent Assay
  • Exocrine Pancreatic Insufficiency / diagnosis
  • Exocrine Pancreatic Insufficiency / enzymology*
  • Exocrine Pancreatic Insufficiency / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Elastase / blood*
  • Pancreatic Function Tests
  • Prevalence
  • Time Factors


  • Pancreatic Elastase