title: [Exocrine pancreatic insufficiency and diabetes mellitus].
abstract: Exocrine pancreatic insufficiency (EPI) in diabetic patients is frequent. Studies based on fecal elastase-1 measurement give prevalence rates of 10‒30 % of severe and 22‒56 % of moderate EPI in type 1 and rates of 5‒46 % in type 2 diabetic patients. Nevertheless, not all patients report typical symptoms like diarrhea, steatorrhea and weight loss. For noninvasive testing the determination of fecal elastase-1 has the highest sensitivity and specificity. This test should be performed at least in all symptomatic patients. As differential diagnosis celiac disease (with a prevalence of about 3-5 % of type 1 diabetic patients), autonomic neuropathy, but also diseases like irritable bowel syndrome and gastrointestinal tumors have to be taken into account. Patients with symptoms and a fecal elastase-1 < 100 µg/g should be treated with pancreatic enzymes in adequate daily doses administered at main meals. Treatment improves symptoms significantly, supply with fat soluble vitamins is normalised, risk for osteoporosis is reduced. However, improvement of glucose metabolism has not been demonstrated consistently. A pancreatogenic diabetes, also termed as type 3c diabetes, has not necessarily to be treated with insulin, often-at least initially-treatment with oral antidiabetic drugs is sufficient.
authors.affiliation: Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich. raimund.weitgasser@pkwd.at.|Universitätsklinik für Innere Medizin I, Landeskrankenhaus Salzburg - Universitätsklinikum, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich. raimund.weitgasser@pkwd.at.
authors.forename: Raimund
authors.initials: R
authors.lastname: Weitgasser
authors.affiliation: Internistisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, Wien, Österreich.
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Abrahamian
authors.affiliation: Interne Abteilung, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich.|Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
authors.forename: Martin
authors.initials: M
authors.lastname: Clodi
authors.affiliation: 1. Medizinische Abteilung, Klinikum Klagenfurt, Klagenfurt, Österreich.
authors.forename: Sandra
authors.initials: S
authors.lastname: Zlamal-Fortunat
authors.affiliation: Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universitätsklinik Graz, Graz, Österreich.
authors.forename: Heinz F
authors.initials: HF
authors.lastname: Hammer
mesh_terms: D001317:Austria / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D004704:Endocrinology / Q000592:standards*; D019317:Evidence-Based Medicine; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Diabetes mellitus; Exocrine pancreatic insufficiency