Abstract
Background: Prior studies have provided data indicating the existence of close interaction between
pancreatic endocrine and exocrine function, but few clinical studies have explored
this relationship in depth. We compared pancreatic exocrine function non-endoscopically
in individuals with type 1 diabetes mellitus, type 2 diabetes mellitus, and normal
glucose tolerant controls, to assess the importance of local insulin production to
pancreatic exocrine function. Methods: The plasma amylase response to intravenous secretin challenge was measured in men
with type 1 diabetes mellitus (n = 5), type 2 diabetes mellitus (n = 5), and normal
controls (n = 3). Patients were characterized by their urinary excretion of c-peptide
and albumin over 24 hours. Autonomic neuropathy was non-invasively assessed by measuring
RR variation (with deep respiration on EKG). Results: Post-secretin amylase responses were generally absent with low baseline levels in
the patients with type 1 diabetes mellitus. Patients with type 2 diabetes mellitus
and controls showed similar twofold increases over baseline after secretin administration.
When normal glucose tolerant and type 2 diabetic patients were pooled and compared
against type 1 diabetes mellitus, the differences were statistically significant (p
< 0.03). Total amylase response correlated positively, but weakly, with 24 h urinary
C-peptide excretion (r = 0.507; p < 0.112), but not with glycemic control, duration
of diabetes, or indices of autonomic neuropathy. Conclusions: Patients with type 1 diabetes mellitus, but not type 2 diabetes mellitus, have reduced
pancreatic exocrine function, supporting the concept of a local paracrine effect of
insulin on pancreatic acinar cells. Further studies are needed to determine the clinical
impact of this deficiency, and whether such patients with type 1 diabetes mellitus
would benefit from therapy with pancreatic enzyme supplementation.
Key words
Plasma amylase - Secretin - Pancreatic exocrine function - Autonomic nervous system
- C-peptide - Diabetes mellitus
References
Diet and diabetes. In: Rifkin H, Raskin P (eds) Diabetes Mellitus, volume 5. Bowie, Maryland; Robert
J. Brady Co 1981 Microalbuminuria: an appraisal of assay techniques and urine collection procedures
for measuring urinary albumin at low concentration. In: Mogensen CE (ed) The kidney and hypertension in diabetes mellitus. Boston; Martinus
Nijhoff 1988: 41-50
Arthur.Swislocki@med.va.gov
