Angelo Andriulli, Antonio Massimo Ippolito, Virginia Festa, Maria Rosa Valvano, Antonio Merla, Fabrizio Bossa, Grazia Niro, Grazia Napolitano, Luigi Benini and Italo Vantini
Objective: To assess the prevalence of pancreatic exocrine insufficiency (PEI) inpatients with diabetes mellitus (DM).
Design: Meta-analysis of prospective, observational studies that used fecal elastase-1 estimation to determine PEI in patients with DM.
Data extraction: A total of 11 studies out of 1156 retrieved references, published between 2000 and 2013, fulfilled the inclusion criteria. The primary outcome measure was proportions of patients with DM and PEI.
Results: Of the 2891 patients enrolled, 921 (31.8%) showed abnormal (i.e, <200 μg/g) fecal elastase-1 excretion. Prevalence of PEI varied across studies, with figures ranging from 5% to 57%. After pooling rates from individual reports, a weighted prevalenceof 31.6% with 95% confidence intervals (CI) of 24.8-39.3 was estimated. Of the 906 patients with abnormal fecal elastase-1, half had severe (<100 μg/g) and half a mild to moderate impairment (>100 but <200 μg/g) in elastase-1 excretion. In 921 patients with type-1 DM, the weighted rate of PEI was 37.7% (CI 27.2-49.5), and 26.2% (CI 19.4-34.3) in 1970 type-2 diabetic patients, a difference of 11.5% (p=0.09). Of patients with abnormal (<200 μg/g) fecal elastase-1 concentrations, severe PEI was present in 53.4% (CI 45.2-61.4) of type-1, and in 50.3% (CI 40.7-59.9) of type-2 diabetic patients.
Limitation: Some variables, which may influence fecal elastase-1 excretion, could not be controlled due to missing data. Conclusions: When explored by fecal elastase-1 testing, one in three patients with DM showed signs of impaired exocrine function. The results suggest that testing for PEI should be part of the diagnostic work-up of patients with DM.