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Abstract
One of the underestimated complications of diabetes is exocrine pancreatic insufficiency (EPI). The consequences of EPI in patients with diabetes include malabsorption syndrome and its complications: deficiencies of fat-soluble vitamins A, D, E, and K, osteoporosis, sarcopenia, and increased overall mortality, which emphasizes the importance of early diagnosis and timely treatment of this pathological condition. The prevalence of diabetes is steadily increasing throughout the world, leading to a proportional increase in the prevalence of secondary pancreatic pathology. The aim of this review is to analyze the available evidence on the pathophysiology, diagnosis, and treatment of EPI in diabetes. Scientometric databases yielded 3 clinical recommendations and 34 papers for analysis. The generalization of the obtained information indicates that the main causes of the development of EPI in diabetes are the deficiency of insulin’s trophic effects and the toxic effects of hyperglycemia. Together, these factors contribute to inflammation, oxidative stress, microvascular and neuropathic disorders, fibrosis, steatosis, and pancreatic parenchyma atrophy. The easiest and most accessible non-invasive way to diagnose this condition is fecal elastase 1 testing. Antidiabetic drugs, such as sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, metformin, and alpha-lipoic acid, have proven to counteract the pathogenesis of EPI in diabetes patients. Recent research has shown that reducing the incidence and severity of EPI in diabetes can be achieved through careful glycemic control, replacement of insulin deficiency, improvement of insulin sensitivity through antidiabetic medication and lifestyle changes, and use of exogenous pancreatic enzyme replacement therapy in the presence of clinical and laboratory signs of malabsorption and nutritional deficiencies.
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