Exocrine pancreas function decreases during the progression of the beta-cell damaging process in young prediabetic children

Pediatr Diabetes. 2018 May;19(3):398-402. doi: 10.1111/pedi.12592. Epub 2017 Oct 17.


Objective: The function of the exocrine pancreas is decreased in patients with type 1 diabetes but it is not known when this defect develops. The current study set out to determine whether the reduced exocrine function becomes manifest after the initiation of islet autoimmunity.

Methods: The study was nested in the prospective Type 1 Diabetes Prediction and Prevention study where children with human leukocyte antigen (HLA)-conferred susceptibility are observed from birth. Elastase-1 levels were analyzed from stool samples collected at the time of seroconversion to islet autoantibody positivity and at diagnosis of type 1 diabetes, as well as from samples taken from matched control children of similar age.

Results: Elastase levels were lower in case children at the time of the diagnosis of diabetes when compared to the control children. However, elastase concentrations did not differ between cases and controls at the time when autoantibodies appeared.

Conclusion: The results suggest that the defect in the exocrine function develops after the appearance of islet autoantibodies. Further studies are needed to assess whether reduced elastase levels predict rapid progression of islet autoimmunity to clinical disease.

Keywords: autoantibodies; pancreatic elastase; prediabetic state; seroconversion; type 1 diabetes mellitus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Autoimmunity
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / immunology
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Feces / enzymology
  • Female
  • Humans
  • Infant
  • Male
  • Pancreas / immunology
  • Pancreas / metabolism*
  • Pancreas / physiopathology
  • Pancreatic Elastase / analysis
  • Prediabetic State / immunology
  • Prediabetic State / physiopathology*


  • Pancreatic Elastase