Type 2 diabetes mellitus is not associated with a clinically relevant exocrine pancreatic phenotype: A prospective multimodal assessor-blinded case-control study.

AIMS: Exocrine pancreatic abnormalities have been reported in type 2 diabetes mellitus (T2DM), but their clinical relevance remains uncertain. We assessed whether T2DM is associated with a clinically meaningful exocrine pancreatic phenotype. METHODS: Adults undergoing endoscopic ultrasound (EUS) for non-pancreatic indications were prospectively enrolled. Patients with known or suspected pancreatic disease were excluded. Non-diabetic controls were frequency-matched to patients with T2DM by sex and age. EUS abnormalities, pancreatic body diameter, elastography, faecal elastase-1 (FE-1), symptoms, GIQLI, PEI-Q and nutritional markers were compared using adjusted models. EUS was performed by endosonographers blinded to diabetes status. RESULTS: We analysed 57 T2DM patients and 53 controls. EUS abnormalities were similar between groups (2.16 ± 1.97 vs 1.77 ± 2.02; p = 0.186), including ≥ 5 abnormalities (15.8% vs 13.2%; p = 0.701). Pancreatic body diameter, mean strain ratio, FE-1, GIQLI, PEI-Q and nutritional markers were comparable. Low FE-1 < 200 µg/g was not more frequent in T2DM (10.9% vs 18.0%). Early satiety and diarrhoea were more frequent in T2DM. CONCLUSIONS: In this selected EUS-referred population without known or suspected pancreatic disease, T2DM was not associated with clinically relevant exocrine dysfunction, pancreatic atrophy or a coherent chronic pancreatitis-like EUS phenotype. These findings support phenotype-based pancreatic function testing in T2DM.