Type 2 diabetes mellitus is not associated with a clinically relevant exocrine pancreatic phenotype: A prospective multimodal assessor-blinded case-control study.

AIMS: Exocrine pancreatic abnormalities have been reported in type 2 diabetes mellitus (T2DM), but their clinical relevance remains uncertain. We assessed whether T2DM is associated with a clinically meaningful exocrine pancreatic phenotype.

METHODS

Adults undergoing endoscopic ultrasound (EUS) for non-pancreatic indications were prospectively enrolled. Patients with known or suspected pancreatic disease were excluded. Non-diabetic controls were frequency-matched to patients with T2DM by sex and age. EUS abnormalities, pancreatic body diameter, elastography, faecal elastase-1 (FE-1), symptoms, GIQLI, PEI-Q and nutritional markers were compared using adjusted models. EUS was performed by endosonographers blinded to diabetes status.

RESULTS

We analysed 57 T2DM patients and 53 controls. EUS abnormalities were similar between groups (2.16 ± 1.97 vs 1.77 ± 2.02; p = 0.186), including ≥ 5 abnormalities (15.8% vs 13.2%; p = 0.701). Pancreatic body diameter, mean strain ratio, FE-1, GIQLI, PEI-Q and nutritional markers were comparable. Low FE-1 < 200 µg/g was not more frequent in T2DM (10.9% vs 18.0%). Early satiety and diarrhoea were more frequent in T2DM.

CONCLUSIONS

In this selected EUS-referred population without known or suspected pancreatic disease, T2DM was not associated with clinically relevant exocrine dysfunction, pancreatic atrophy or a coherent chronic pancreatitis-like EUS phenotype. These findings support phenotype-based pancreatic function testing in T2DM.