Evaluation Of Pancreatic Exocrine Function In Type 2 Diabetes Mellitus

Objective:1.To evaluate the pancreatic exocrine function(PEF)and measure the prevalence rate of pancreatic exocrine insufficiency(PEI)in type 2 diabetes mellitus(T2DM).2.To investigate the influence factors to PEF in T2DM.3.To discuss the effect of body mass index(BMI)on PEF,endocrine function,and metabolic marks in T2DM.Methods:1.The study was carried out among 188 T2DM patients from endocrinology department in Zhongda Hospital.The level of fecal elastase-1(FE-1)was tested to evaluate the PEF and measure the prevalence rate of PEI in T2DM.2.Fasting blood draw were taken to detect triglyceride(TG),total cholesterol(TC),uric acid(UA),fasting plasma glucose(FPG),fasting insulin(FINS),fasting C-peptide(FCP)and height,weight were measured.Homeostasis model was adopted to assess the?-cell function (HOMA-?).Then we analyzed the correlations about FE-1 and multiple linear regression model was used to evaluate the risk factors to FE-1.3.The subjects with T2DM were assigned to underweight group(BMI<18.5),normal group (18.5?BMI<23),overweight group(23?BMI<27.5)and obesity group(BMI?27.5) according to BMI.The FE-1 level,endocrine function and metabolic markers trends were compared between four groups.Results:1.The median level of FE-1 was 684.65(577.37,721.84)ug/g in 188 T2DM patients and the prevalence rate of PEI was 8.5%(6/188).Spearman correlation showed positive correlations between FE-1 and FINS(?=0.539,P<0.001)?FCP(?=0.523,P<0.001);the partial correlation showed no association(P>0.05)between FE-1 and HOMA-?.2.The UA,FINS and FE-1 had significant difference(P<0.05)between four groups assigned by BMI,but sex,age,diabetic duration,FPG,TG,TC,FCP and HOMA-?had no difference(P>0.05)between four groups.The multiple linear regression model showed age(?=-0.174,P=0.016)and BMI(?=0.154,P=0.033)were risk factors to FE-1.3.The FE-1 level in underweight group was the lowest.The level of normal[699.20(528.23,722.95)ug/g,P=0.003]and overweight group[713.26(664.06,728.72)ug/g,P<0.001]were elevated compared to underweight group.The FE-1 level in obesity group was decreased compared to overweight group(P<0.001),lower than that in normal group and higher than that in underweight group.The FE-1 level of normal group made significant difference (P=0.042)to overweight and obesity(P=0.009)group,meanwhile the FE-1 level between overweight and obesity group also made difference(P<0.001).4.With the increase of BMI,the variation tendency of metabolic markers including FPG,UA,TG,TC accorded to BMI while FINS,FCP,HOMA-?,FE-1 were increasing gradually and were in the peak in overweight group and decreased in obesity group.Conclusions:1.The FE-1 level was positively correlated to FINS and FCP in T2DM,which indicating the close connection between PEF and endocrine function.2.BMI was the risk factor to PEI in T2DM.Along with the rising of BMI,the FE-1 level increased when BMI<27.5kg/m~2 and decreased when BMI?27.5kg/m~2.