Adjunctive pancreatin therapy enhances glycemic and metabolic outcomes in type 2 diabetes mellitus: the modifying role of exocrine pancreatic function.

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.