Introduction

Pancreatic fibrosis and exocrine pancreatic insufficiency have been described in patients with type II DM.

Aims & Methods

Aim of our study was to evaluate the degree of pancreatic fibrosis and exocrine pancreatic secretion in patients with type II DM.
Methods: A prospective, single-centre, age- and sex-matched case-control study was performed. Diabetic (cases) and non-diabetic (controls) patients undergoing endoscopic ultrasound (EUS) for a non-pancreatic indication were invited to participate in the study. Linear echoendoscopes (Pentax 34J10, 38J10, and Fujifilm 740UT) and the Arietta-850 ultrasound system were used. The number of EUS criteria described for CP by the Rosemont classification was calculated. Pancreatic fibrosis was assessed in the head, body, and tail of the pancreas by EUS elastography and expressed as strain ratio (SR). Faecal elastase was quantified to assess pancreatic secretion. Data are presented as percentages, mean ± standard deviation or [95% confidence interval]. Results in cases and controls were compared using Fisher's exact test and Student-t test or U-Mann-Whitney test, as appropriate.

Results

Based on previous sample size calculation, 57 cases (age 66.6±9.3 years, 31 males) and 54 controls (age 65.9±9.5 years, 30 males) were included. Body mass index was 29.2±5 in diabetic patients and 27.5±4.7 in controls (p=0.087). The number of EUS criteria was 2.2 [1.6-2.7] in diabetics and 1.8 [1.2-2.3] in controls (p=0.34). The degree of fibrosis in the head of the pancreas was higher in diabetics (SR=2.82 [2.53-3.11]) than in controls (SR=2.44 [2.25-2.63]) (p=0.031), but not in the body and tail. Faecal elastase was similar in diabetic patients (516.9 [454.6-579.2] mcg/g) and controls (475.8 [408.3-543.3] mcg/g) (p=0.371). Six cases and nine controls had faecal elastase less than 200 mcg/g (p=0.32). Morphological and functional changes of the exocrine pancreas were not associated with the time since the onset of DM.

Conclusion

Type II DM is not associated with significant morphological, fibrotic, and functional changes in the exocrine pancreas as assessed by EUS, EUS-elastography and faecal elastase. EUS elastography shows a higher degree of pancreatic fibrosis in the head in patients with DM compared to non-diabetic subjects. This study challenges previous studies of exocrine pancreatic changes in type II DM.

Disclosure

Julio Iglesias-Garcia: Advisor Fuji