Diabetes research and clinical practice · 2025
Adjunctive pancreatin therapy enhances glycemic and metabolic outcomes in type 2 diabetes mellitus: the modifying role of exocrine pancreatic function.
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Koca Nizameddin, Yalçın Nazif
Аннотация
OBJECTIVE: Exocrine pancreatic dysfunction is an underrecognized comorbidity in type 2 diabetes mellitus (T2DM) that may impair glycemic control via malabsorption, vitamin D deficiency, and reduced incretin stimulation. We evaluated the effect of adjunctive pancreatin therapy on metabolic outcomes in T2DM and examined the modifying role of exocrine function.
METHODS: In this retrospective cohort, 256 patients with T2DM were analyzed, including 128 prescribed pancreatin and 128 propensity-matched controls. Fecal elastase-1 (FE-1) was used to assess exocrine reserve. The primary outcome was HbA1c change; secondary outcomes included fasting glucose, triglycerides, liver enzymes, and 25(OH) vitamin D. Multivariable regression incorporated an interaction term for treatment × FE-1.
RESULTS: Both groups demonstrated HbA1c reductions, but the decrease was greater with pancreatin (-1.3 ± 1.0 % vs -1.1 ± 0.9 %; p = 0.014). Baseline HbA1c (β = 0.419, p < 0.001) and FE-1 (β = -0.0025, p < 0.001) independently predicted HbA1c change. The treatment × FE-1 interaction was significant (β = -0.0088, p < 0.001), indicating that the incremental benefit of pancreatin emerged below ∼ 80 µg/g. Patients with FE-1 < 100 µg/g exhibited the most pronounced glycemic improvements. Secondary benefits in triglycerides and vitamin D were observed.
CONCLUSIONS: Adjunctive pancreatin provides modest glycemic benefit in T2DM, primarily in patients with severe exocrine dysfunction. Targeted use guided by FE-1 testing may enable a more personalized therapeutic strategy.
METHODS: In this retrospective cohort, 256 patients with T2DM were analyzed, including 128 prescribed pancreatin and 128 propensity-matched controls. Fecal elastase-1 (FE-1) was used to assess exocrine reserve. The primary outcome was HbA1c change; secondary outcomes included fasting glucose, triglycerides, liver enzymes, and 25(OH) vitamin D. Multivariable regression incorporated an interaction term for treatment × FE-1.
RESULTS: Both groups demonstrated HbA1c reductions, but the decrease was greater with pancreatin (-1.3 ± 1.0 % vs -1.1 ± 0.9 %; p = 0.014). Baseline HbA1c (β = 0.419, p < 0.001) and FE-1 (β = -0.0025, p < 0.001) independently predicted HbA1c change. The treatment × FE-1 interaction was significant (β = -0.0088, p < 0.001), indicating that the incremental benefit of pancreatin emerged below ∼ 80 µg/g. Patients with FE-1 < 100 µg/g exhibited the most pronounced glycemic improvements. Secondary benefits in triglycerides and vitamin D were observed.
CONCLUSIONS: Adjunctive pancreatin provides modest glycemic benefit in T2DM, primarily in patients with severe exocrine dysfunction. Targeted use guided by FE-1 testing may enable a more personalized therapeutic strategy.