Does Pancreatic Elastase-1 in Stools Predict Steatorrhea in Type 1 Diabetes?
- Franco Cavalot, MD1,
- Katia Bonomo, MD1,
- Elisa Fiora, MD1,
- Elisa Bacillo, PHD2,
- Paola Salacone, MD2,
- Massimo Chirio, MD1,
- Ezio Gaia, MD2 and
- Mariella Trovati, MD1
- 1Department of Clinical and Biological Sciences, Diabetes Unit, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
- 2Department of Internal Medicine, Gastroenterology Unit, San Luigi Gonzaga Hospital, Turin, Italy
- Address correspondence reprint requests to Mariella Trovati, MD, Diabetes Unit, Department of ClinicalBiological Sciences, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy. E-mail: mariella.trovati{at}unito.it
Areduction of exocrine pancreas function frequently occurs in type 1 diabetes (1), and its detection has been made easy by measurement of fecal pancreatic elastase-1 (PE-1) (2,3). We recently observed that PE-1 correlates in these patients with poor blood glucose control, diabetes duration, and residual β-cell function (4). A possible consequence of severe pancreatic insufficiency is steatorrhea, defined as a daily fecal fat excretion (FFE) >6 (1) or >7 (5) g/day for subjects consuming 100 g of fat per day (1,5,6). Testing FFE requires multiple daily stool collections (6) and is not routinely feasible in asymptomatic subjects, being poorly accepted by patients and disliked by laboratory technicians. We considered here the hypothesis that low PE-1 identifies patients to be submitted to FFE measurement for steatorrhea detection.
RESEARCH DESIGN AND METHODS
We studied, with the approval of the ethical committee of our institution and the subjects’ informed consent, 66 consecutive type 1 diabetic subjects in regular follow-up at our diabetes clinic without history or symptoms of gastrointestinal disease and negative for anti-transglutaminase, anti-gliadin, and anti-endomysium antibodies checked to exclude celiac disease. Their clinical features were 32 men and 34 women aged (means ± SD) 36.7 ± 12.1 years, age at diagnosis 22.7 ± 13.6 years, diabetes duration 13.9 ± 9.7 years, BMI 24.6 ± 3.7 kg/m2, fasting C-peptide 0.21 ± 0.32 ng/ml (radioimmunoassay; Adaltis, Bologna, Italy), Diabetes Control and Complications Trial–aligned HbA1c 8.4 ± 1.4% (high-performance liquid chromatography, Bio-Rad Variant II Total GHb Program; Bio-Rad Laboratories, Munchen, Germany; calibrated to the Diabetes Control and Complications Trial through the U.S. National Glycohemoglobin Standardized Protocol), and daily albumin excretion rate (AER) 35.3 ± 63.7 μg/min (nephelometry; Beckman, Milan, Italy). A total of 49 subjects were normoalbuminuric, 15 were micro- and 2 macroalbuminuric, 45 presented no diabetic retinopathy, 14 …
