13C-mixed triglyceride breath test for evaluation of pancreatic exocrine function in diabetes mellitus.
OBJECTIVE
The clinical relevance of pancreatic exocrine insufficiency (PEI) in diabetic patients is unclear mostly because established function tests are invasive and expensive or lack sensitivity and specificity. A modified version of the noninvasive 13C-mixed triglyceride breath test (13C-MTGT) has recently been shown to detect moderate PEI reliably in patients with chronic pancreatitis. Its sensitivity and specificity in other patient groups are unknown. We therefore aimed to clarify the significance of this test for patients with diabetes mellitus (DM).


METHODS
A secretin cerulein test and a modified 13C-MTGT were performed in 14 patients with DM (10 patients with type 1 DM) and 10 healthy volunteers.


RESULTS
Secretin cerulein test showed significantly lower outputs of amylase, trypsin, and lipase in DM compared with healthy volunteers (P < 0.05). Likewise, 13C-MTGT showed significantly lower maximal and cumulative 13C-exhalation in DM (P < 0.005). Stimulated lipase output correlated with cumulative 13C-exhalation (P < 0.05). However, when compared with normal values, only 2 patients with diabetes had abnormally low lipase output, whereas cumulative 13C-exhalation was pathologically decreased in 8 patients, including those with decreased lipase output.


CONCLUSIONS
The noninvasive 13C-MTGT can detect mild to moderate PEI in DM. However, the specificity of the 13C-MTGT is low in these patients probably because nonpancreatic mechanisms contribute to decreased intestinal lipolysis.
From the Department of Internal Medicine, Israelitic Hospital, University of Hamburg, Hamburg, Germany.
Jutta
J
Keller
Peter
P
Layer
Sebastian
S
Brückel
Christine
C
Jahr
Ulrich
U
Rosien
D000328:Adult; D000368:Aged; D001944:Breath Tests / Q000379:methods*; D002247:Carbon Isotopes; D002108:Ceruletide; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000503:physiopathology*; D010186:Pancreatic Function Tests / Q000379:methods; D011788:Quality of Life; D015203:Reproducibility of Results; D012633:Secretin; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014280:Triglycerides; D055815:Young Adult
D002247:Carbon Isotopes; D014280:Triglycerides; D012633:Secretin; D002108:Ceruletide