High prevalence of low faecal elastase levels in individuals with type 1 diabetes is associated with diabetes duration but not with marked alterations in food intake or clinical symptoms.

AIMS/HYPOTHESIS: Although exocrine pancreatic insufficiency (EPI) is thought to be common in type 1 diabetes, little is known about the relationship of EPI with type 1 diabetes parameters or food intake and abdominal complaints. Characterising individuals with EPI could help prevent EPI-related complications such as malabsorption and osteoporosis. METHODS: In a cross-sectional cohort of 443 individuals with type 1 diabetes (62% female, median age 42 years [IQR 29-54], mean BMI 25±4 kg/m2, median diabetes duration 16 years [IQR 6-29]), we associated faecal elastase (FE) levels, as a marker of EPI, with type 1 diabetes parameters and clinical features, using linear and Poisson regression models. RESULTS: The mean FE level (±SD) was 349.5±146.8 µg/g faeces. A number of variables were independently associated with lower FE levels: older age (-10.97 µg/g faeces per 10 years; 95% CI -21.02, -0.92), longer diabetes duration (-13.09 µg/g per 10 years; 95% CI -23.54, -2.64), higher HbA1c (-1.44 mmol/mol per 1 SD increase in FE levels, 95% CI -2.59, -0.30), male sex (-54.07 µg/g; 95% CI -81.41, -26.73) and smoking (-85.06 µg/g; 95% CI -128.52, -41.60). In a linear analysis, we found no evidence of associations between FE levels and markers of residual beta cell function, liver disease, macronutrient intakes or gastrointestinal complaints. Using a cut-off of 200 µg/g faeces, 76 individuals (17%) were found to have EPI, which was associated with a 4.31 mmol/mol (0.39%) higher HbA1c (95% CI 1.35, 7.26), an 8% higher mean glucose (95% CI 2, 14), a 9% lower fibre intake (95% CI 1, 17) and an 8% lower energy intake (95% CI 1, 15). CONCLUSIONS/INTERPRETATION: The lack of evidence for associations with clinical parameters in this relatively healthy population of individuals with type 1 diabetes does not support the use of FE for routine screening for EPI. However, the high prevalence of low FE levels and their association with lower food intake and higher glucose levels justify a need for clinical awareness for EPI and its complications, especially in individuals with long diabetes duration.