Does Pancreatic Elastase-1 in Stools Predict Steatorrhea in Type 1 Diabetes?

A reduction of exocrine pancreasfunction frequently occurs in type 1diabetes (1), and its detection has been made easy by measurement of fecal pancreatic elastase-1 (PE-1) (2,3). We re-cently observed that PE-1 correlates in these patients with poor blood glucose control, diabetes duration, and residual -cell function (4). A possible conse-quence of severe pancreatic insufficiency is steatorrhea, defined as a daily fecal fat excretion (FFE) 6 (1) or 7 (5) g/day for subjects consuming 100 g of fat per day (1,5,6). Testing FFE requires multi-ple daily stool collections (6) and is not routinely feasible in asymptomatic sub-jects, being poorly accepted by patients and disliked by laboratory technicians. We considered here the hypothesis that low PE-1 identifies patients to be submit-ted to FFE measurement for steatorrhea detection. RESEARCH DESIGN AND METHODS — We studied, with the approval of the ethical committee of our institution and the subjects ’ informed consent, 66 consecutive type 1 diabetic subjects in regular follow-up at our dia-betes clinic without history or symptoms of gastrointestinal disease and negative for anti-transglutaminase, anti-gliadin, and anti-endomysium antibodies checked to exclude celiac disease. Their clinical fea-tures were 32 men and 34 women aged (means SD) 36.7 12.1 years, age at diagnosis 22.7 13.6 years, diabetes du-