Diabetes and the Exocrine Pancreatic Insufficiency Connection
While diabetes is a disorder of endocrine function of the pancreas, exocrine pancreatic insufficiency has been shown to occur more frequently in patients with diabetes. It is felt that diabetics with excess weight, generally with BMI greater than 25 are at increased risk. The studies that show this association generally showed that fecal elastase levels were lower in patients with both type 1 and type 2 Diabetes. Other studies have shown changes in the pancreas in patients with diabetes, including microscopic, ultrasound, CT scan findings.
There have been many thoughts as to why there is exocrine pancreas insufficiency in diabetics. One is that since insulin leads to growth of pancreas tissue, an insulin deficiency may lead to atrophy of the pancreas. It is also felt that regulation of exocrine function might be impaired in diabetes as well. As patients with diabetics can have neurologic issues (neuropathy), such neuropathy can possibly lead to impairment in pancreatic reflexes responsible for the exocrine system to function, and therefore lead to exocrine dysfunction. It is well known that diabetics have disease of small blood vessels. It is thought that possibly lesions of small arteries can lead to fibrosis of the pancreas and exocrine dysfunction.
As the actual cause of diabetes is not understood, some people feel that possibly a viral etiology may be responsible for diseases of both the endocrine (diabetes) and exocrine pancreas. Similarly, autoimmune diseases could affect the whole gland as well.
It is unclear as to if exocrine pancreatic insufficiency is a complication of diabetes or the reason for diabetes, Interestingly, it is felt that is the exocrine insufficiency of patients with exocrine pancreatic insufficiency was treated aggressively, by treating the exocrine pancreas insufficiency with pancreatic enzyme replacement, some diabetics have been shown to have improved glucose control and a decreased requirement for insulin. As fat malabsorption has been shown to have an impact on glucose metabolism and to be associated with a reduction of vitamin D levels and osteoporosis, potentially treating diabetics with pancreas hormone replacement, even in the absence of measurable steatorrhea may be beneficial in such patients.
-Dr. Todd Eisner, MD