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Journal of Diabetology | Volume 3
May 16-17, 2019 | Prague, Czech Republic
Diabetes and Endocrinology
27th International Conference on
J Diabetol, Volume 3
The exocrine dysfunctions in diabetes is an unrecognised
problem in the community. There are no adequate data
available to quote the exact number of cases. It is estimated
to be in 50% of diabetic patients in retrospective historical
observational studies. The exocrine pancreas secretes
enzymes that digest carbohydrates, proteins, fats and
bicarbonates for neutralisation of acidic chyme from the
stomach. Exocrine pancreas consists of 80% to 85 % of
the pancreas rest of the gland constitutes the endocrine
portion. Functional unit of the exocrine pancreas: Acinus.
Pancreatic exocrine insufficiency is the condition where
there is inadequate secretion of enzymes in response to the
food to maintain normal digestion. The main reasons areas
follow, inadequate secretions of pancreatic enzymes, reduced
production, reduced secretion, insufficient stimulation,
inadequate acid mediated inactivation and obstruction
to pancreatic duct. The main clinical consequence of the
pancreatic exocrine insufficiency is fat malabsorption and
digestion leading to steatorrhea’s studies have shown that in
almost 50 percent of diabetics have pancreatic dysfunction.
In type 1 diabetes up to 51 % and in type 2 diabetes it is up
to 32%. There are few theories of pathophysiology of the
exocrine dysfunction in types 1 and 2 which are as follow
pancreatic islet cells hormones regulatory functions may be
impairment, diabetic neuropathy, diabetic angiopathy causing
impaired blood flow leading to fibrosis and atrophy, elevated
hormones and peptide concentration example somatostatin
and glucagon may suppress exocrine function, concurrent
damage done by viral infections, genetics autoimmune
changes. The reclassification study talks about type 1 presence
of autoantibodies early onset, early requirement, type 2
absence of autoantibodies, no (late) insulin requirement,
insulin resistance, type 3 absence of autoantibodies, exocrine
pancreatic insufficiency, typical morphological findings. The
investigationsforthediagnosisPancreaticexocrinedysfunction
are done by faecal elastase concentration (most commonly
available) with the formed stool, coefficient of fat absorption
(gold standard), carbon 13 (13C) mixed triglyceride breath
test (not widely available). The main clinical consequences
of Pancreatic exocrine dysfunction are steatorrhea, and this
is evident when almost 90% of pancreatic function is lost
however experts suggests that early recognition, screening of
pancreatic exocrine dysfunction is valuable as their thoughts
are it could happen at earlier stage of the disease. Clinical signs
are abdominal pain, flatulence, weight loss and steatorrhea?
Glycaemic control (yet to be explored). The treatment with
Pancreatin improves HbA1C, improvement in clinical sign,
improves in increatin effects, fewer hypos. Do we routinely
ask for Gastrointestinal side effects in our diabetic patients,
most often no and is put down to medication (metformin)
and autonomic dysfunction rather that Pancreatic exocrine
dysfunction? I think it is time to rethink the way we look
at diabetes and pancreatic insufficiency. Early recognition
can treat the pancreatic exocrine dyfuncyion and in fact
improve HbA1C and reduce the risk of the complications
associated with diabetes.
Speaker Biography
RekhaAnniePrasad isaconsultantphysicianatatertiaryhospitalandworks
at other sites. She has been a clinician in Australia for the past 18 years
with varied experience, remote and in urban areas. She has her speciality
interests as acute medicine, pre and peri operative medicine, obstetric
medicine. She is passionate about diabetes management and chronic
disease management especially in aboriginal population. She is involved in
teachingundergraduatestudentsforNotreDameUniversityandUniversity
of Western Australia. She is also a mentor for post graduate students taking
their fellowship exams. She is on the safety and medication committee of
Sir Charles Gardiner Hospital. She is also a panel member of undiagnosed
disease panel in Western Australia. She also practices tele-medicine for
remote communities dealing with chronic diseases especially diabetes.
e:
Rekha Annie Prasad
Sir Charles Gardiner Hospital, Australia
Epidemiology, pathophysiology, investigations, treatment for
exocrine dysfunction of diabetes