ORIGINAL ARTICLE

Does Blood Glucose Regulation in Adults with Type 2 Diabetes Affect Exocrine Pancreatic Functions?
Tip 2 Diyabetli Erişkinlerde Kan Şekeri Regülasyonu Ekzokrin Pankreas Fonksiyonlarını Etkiler mi?
Received Date : 01 Nov 2020
Accepted Date : 01 Feb 2021
Available Online : 09 Mar 2021
Doi: 10.25179/tjem.2020-79839 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:87-94
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: The purpose of this study was to assess the possible effects of blood glucose regulation on pancreatic exocrine functions in type 2 diabetes mellitus (T2DM) patients with poor glycemic control. Material and Methods: This prospective clinical study was performed with 20 patients with poorly controlled T2DM (HbA1c >10%) and age- and sex-matched 20 healthy controls. At the beginning of the study, metabolic parameters and fecal elastase-1 (FE-1) levels, one of the markers of pancreatic exocrine insufficiency (PEI), were compared between the patient and control groups. In addition, after blood glucose regulation was achieved with at least three months of intensive insulin therapy in the patient group, FE-1 levels and metabolic parameters were compared with pre-treatment. PEI was defined as FE-1 levels lower than 200 μg/g. Results: FE-1 levels were significantly lower in the T2DM group than the control group (median values for patients=333.1 μg/g and controls= 508.5 μg/g; p=0.013). PEI was detected in three patients (15%) but none in the control group. After intensive insulin therapy, T2DM patients FE-1 levels significantly increased compared to their pre-treatment (pre-treatment median: 333.15 (192.60) μg/g, post-treatment median: 415.40 (300.77) μg/g; p=0.044). The major factors impacting this increase were the duration of diabetes and the change in HbA1c levels. Conclusions: FE-1 levels in patients with poorly controlled T2DM were lower than the healthy control group, which significantly increased with blood glucose regulation.
ÖZET
Amaç: Bu çalışmada, glisemik kontrolü zayıf olan Tip 2 diabetes mellitus hastalarında kan şekeri regülasyonunun pankreas ekzokrin fonksiyonları üzerine etkisini değerlendirmek amaçlandı. Gereç ve Yöntemler: Bu prospektif klinik çalışma, kan şekeri regülasyonu bozuk (HBA1c >10) Tip 2 diyabetes mellituslu 20 hasta ile cinsiyet ve yaş uyumlu 20 sağlıklı kontrol grubundan oluşan bir popülasyonda gerçekleştirilmiştir. Çalışmanın başlangıcında pankreas ekzokrin yetmezliği belirteçlerinden biri olan fekal elastaz 1 (FE-1) düzeyleri ve metabolik parametreler hasta ve kontrol grubu arasında karşılaştırıldı. Ayrıca hasta grubunda en az 3 ay yoğun insülin tedavisi ile kan şekeri regülasyonu sağlandıktan sonra FE-1 düzeyleri ve metabolik parametreler tedavi öncesi ile karşılaştırıldı. Fekal elastaz 1 düzeylerinin 200 μg/g‘ın altında olması pankreas ekzokrin yetmezliği olarak tanımlandı. Bulgular: Diyabetik hasta grubunda kontrol grubuna göre FE-1 düzeyleri anlamlı olarak daha düşük bulundu (Medyan: Hasta grubu=333,1 μg/g; Kontrol grubu= 508,5 μg/g; P=0,013). Hasta grubunda 3 (%15) hastada ekzokrin pankreas yetmezliği görülürken kontrol grubunda ekzokrin pankreas yetmezliği görülmedi. Hasta grubunda FE-1 düzeyleri kan şekeri regülasyonu öncesine göre anlamlı olarak arttı (tedavi öncesi medyan=333,15 (192,60) μg/g, tedavi sonrası medyan=415,40 (300,77) μg/g; P=0,044) ve bu artışa etki eden majör faktörler diyabet süresi ve HbA1c düzeyindeki değişimdi. Sonuç: Çalışmamızda kan şekeri regülasyonu bozuk Tip 2 diabetes mellitus hastalarında fekal elastaz 1 düzeyleri sağlıklı kontrol grubuna göre daha düşüktü ve bu hastalarda kan şekeri regülasyonunun sağlanması FE-1 düzeylerini anlamlı olarak artırdı.
KAYNAKLAR
  1. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129-139.[Crossref] [PubMed] [PMC] 
  2. Wynne K, Devereaux B, Dornhorst A. Diabetes of the exocrine pancreas. J Gastroenterol Hepatol. 2019;34:346-354.[Crossref] [PubMed] 
  3. Zsóri G, Illés D, Terzin V, Ivány E, Czakó L. Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review. Pancreatology. 2018;18:559-565.[Crossref] [PubMed] 
  4. Altay M. Which factors determine exocrine pancreatic dysfunction in diabetes mellitus? World J Gastroenterol. 2019;25:2699-2705.[Crossref] [PubMed] [PMC] 
  5. Domínguez-Mu-oz JE, D Hardt P, Lerch MM, Löhr MJ. Potential for screening for pancreatic exocrine insufficiency using the fecal elastase-1 test. Dig Dis Sci. 2017;62:1119-1130.[Crossref] [PubMed] 
  6. Whitcomb DC, Bodhani A, Beckmann K, Sander-Struckmeier S, Liu S, Fuldeore M, Pollack PF, Khurmi RP. Efficacy and safety of pancrelipase/pancreatin in patients with exocrine pancreatic insufficiency and a medical history of diabetes mellitus. Pancreas. 2016;45:679-686.[Crossref] [PubMed] 
  7. Mohan V, Poongothai S, Pitchumoni CS. Oral pancreatic enzyme therapy in the control of diabetes mellitus in tropical calculous pancreatitis. Int J Pancreatol. 1998;24:19-22.[PubMed] 
  8. Ewald N, Bretzel RG, Fantus IG, Hollenhorst M, Kloer HU, Hardt PD; S-2453110 Study Group. Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of a prospective multi-centre trial. Diabetes Metab Res Rev. 2007;23:386-391.[Crossref] [PubMed] 
  9. Riceman MD, Bound M, Grivell J, Hatzinikolas S, Piotto S, Nguyen NQ, Jones KL, Horowitz M, Rayner CK, Phillips LK. The prevalence and impact of low faecal elastase-1 in community-based patients with type 2 diabetes. Diabetes Res Clin Pract. 2019;156:107822.[Crossref] [PubMed] 
  10. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41:S13-S27.[Crossref] [PubMed] 
  11. Field AP. Discovering Statistics Using SPSS (3rd ed). Los Angeles; Sage; 2009.[Link] 
  12. Søfteland E, Poulsen JL, Starup-Linde J, Christensen TT, Olesen SS, Singh S, Vestergaard P, Drewes AM, Dimcevski G. Pancreatic exocrine insufficiency in diabetes mellitus - prevalence and characteristics. Eur J Intern Med. 2019;68:18-22.[Crossref] [PubMed] 
  13. Vujasinovic M, Zaletel J, Tepes B, Popic B, Makuc J, Epsek Lenart M, Predikaka M, Rudolf S. Low prevalence of exocrine pancreatic insufficiency in patients with diabetes mellitus. Pancreatology. 2013;13:343-346.[Crossref] [PubMed] 
  14. Ewald N, Raspe A, Kaufmann C, Bretzel RG, Kloer HU, Hardt PD. Determinants of exocrine pancreatic function as measured by fecal elastase-1 concentrations (FEC) in patients with diabetes mellitus. Eur J Med Res. 2009;14:118-122.[Crossref] [PubMed] [PMC] 
  15. Cavalot F, Bonomo K, Perna P, Bacillo E, Salacone P, Gallo M, Mattiello L, Trovati M, Gaia E. Pancreatic elastase-1 in stools, a marker of exocrine pancreas function, correlates with both residual beta-cell secretion and metabolic control in type 1 diabetic subjects. Diabetes Care. 2004;27:2052-2054.[Crossref] [PubMed] 
  16. Terzin V, Várkonyi T, Szabolcs A, Lengyel C, Takács T, Zsóri G, Stájer A, Palkó A, Wittmann T, Pálinkás A, Czakó L. Prevalence of exocrine pancreatic insufficiency in type 2 diabetes mellitus with poor glycemic control. Pancreatology. 2014;14:356-360.[Crossref] [PubMed] 
  17. Mueller B, Radko F, Diem P. Pancreatic elastase-1 in stools, a marker of exocrine pancreas function, correlates with both residual beta-cell secretion and metabolic control in type 1 diabetic subjects: response to Cavalot et al. Diabetes Care. 2005;28:2809-2810.[Crossref] [PubMed] 
  18. Larger E, Philippe MF, Barbot-Trystram L, Radu A, Rotariu M, Nobécourt E, Boitard C. Pancreatic exocrine function in patients with diabetes. Diabet Med. 2012;29:1047-1054.[Crossref] [PubMed] 
  19. Radlinger B, Ramoser G, Kaser S. Exocrine pancreatic insufficiency in Type 1 and Type 2 diabetes. Curr Diab Rep. 2020;20:18.[Crossref] [PubMed] [PMC] 
  20. Dominguez-Mu-oz JE. Diagnosis and treatment of pancreatic exocrine insufficiency. Curr Opin Gastroenterol. 2018;34:349-354.[Crossref] [PubMed] 
  21. Alexandre-Heymann L, Lemoine AY, Nakib S, Kapel N, Ledoux S, Larger E. Nutritional markers in patients with diabetes and pancreatic exocrine failure. Acta Diabetol. 2019;56:651-658.[Crossref] [PubMed] 
  22. Lindkvist B, Nilsson C, Kvarnström M, Oscarsson J. Importance of pancreatic exocrine dysfunction in patients with type 2 diabetes: A randomized crossover study. Pancreatology. 2018;18:550-558.[Crossref] [PubMed]