Faecal elastase testing and factors linked with development of pancreatic exocrine insufficiency in diabetes: the Belfast Trust experience

Background: Pancreatic exocrine insufficiency (PEI) is characterised by inadequate secretion of pancreatic enzymes and can result in significant gastrointestinal symptoms, malabsorption and increased morbidity. Aims: To evaluate testing for PEI (with faecal elastase - FEL-1) among patients with diabetes mellitus in the Belfast Trust, and to identify factors that were associated with the development of PEI. Methods: Clinical and laboratory data were obtained from electronic health care records. PEI was assessed by FEL-1. Based on FEL-1 levels (mu g/g faeces), patients were categorised to have severe PEI (<100), moderate PEI (100-200) and normal (>200). A retrospective analysis of all FEL-1 samples in patients with diabetes mellitus/pre-diabetes between 1 February 2019 and 1 February 2020 was undertaken. Results: Of the 536 FEL-1 samples analysed by the Belfast Trust over the 12-month period, 162 (30%) were from diabetic or pre-diabetic patients. A total of 128 (80%) had normal FEL-1 results, nine (5%) moderate PEI, and 25 (15%) severe PEI. Of the 34 with PEI, 30/34 (88%) had gastrointestinal symptoms at diagnosis of PEI. For those with PEI, three had type 1 diabetes, 15 had type 2 diabetes, 16 had secondary diabetes mellitus; 28/34 (82%) were not on pancreatic enzyme replacement therapy previously. Source of testing for those confirmed with PEI included inpatients (n=12), general practice patients (n=5) and outpatients (n=17). PEI was associated more with male gender, those with type 3c diabetes (pancreatic diabetes) and worse glycaemic control. Summary: From our cohort, 1 in 4 FEL-1 samples sent from patients with diabetes had PEI. There is potential for targeted screening for symptoms in this population which could increase diagnostic rates of PEI and subsequent treatment with pancreatic enzyme replacement therapy. Copyright (c) 2022 John Wiley & Sons.