Relationship between Pancreas Exocrine Insufficiency and Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus
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Abstract
Background: The exocrine function of the pancreas is controlled by the autonomic nervous system (ANS), and autonomic neuropathy is
a common and serious complication of diabetes. There are many factors contributing to the development of autonomic neuropathy in
diabetic patients. Cardiovascular tests have been developed to evaluate the function of the ANS. This study investigated the relationship
between cardiovascular autonomic neuropathy (CAN) and pancreas exocrine insufficiency (PEI) in diabetic patients.
Methods: This study evaluated 110 individuals with type 2 diabetes mellitus (T2DM) and 40 healthy volunteers. Autonomous neuropathy
tests were utilized to diagnose patients, and Ewing and Clarke’s criteria were employed to assess the severity of autonomous dysfunction.
Stool samples were also collected from patients to measure fecal elastase-1 (FE-1).
Results: A 65.5% incidence of PEI was observed in DM patients. There was no significant correlation among the duration of disease,
C-peptide, HbA1c, and PEI, respectively (P = .782, P = .521, P = .580). However, a significant difference between DM patients and controls
in terms of cardiac dysautonomia (P = .001) was seen. Moreover, a statistically significant correlation between the degree of cardiac
dysautonomia and FE-1 level was observed within the patient group (P =.001).
Conclusion: It is possible that the disruption of exocrine hormone secretion in the pancreas due to the impairment of enteropancreatic
reflexes is secondary to diabetic autonomic neuropathy and resulting in PEI. This study also showed that autonomic neuropathy might
develop and cause PEI in diabetic patients without known added confounding factors.
a common and serious complication of diabetes. There are many factors contributing to the development of autonomic neuropathy in
diabetic patients. Cardiovascular tests have been developed to evaluate the function of the ANS. This study investigated the relationship
between cardiovascular autonomic neuropathy (CAN) and pancreas exocrine insufficiency (PEI) in diabetic patients.
Methods: This study evaluated 110 individuals with type 2 diabetes mellitus (T2DM) and 40 healthy volunteers. Autonomous neuropathy
tests were utilized to diagnose patients, and Ewing and Clarke’s criteria were employed to assess the severity of autonomous dysfunction.
Stool samples were also collected from patients to measure fecal elastase-1 (FE-1).
Results: A 65.5% incidence of PEI was observed in DM patients. There was no significant correlation among the duration of disease,
C-peptide, HbA1c, and PEI, respectively (P = .782, P = .521, P = .580). However, a significant difference between DM patients and controls
in terms of cardiac dysautonomia (P = .001) was seen. Moreover, a statistically significant correlation between the degree of cardiac
dysautonomia and FE-1 level was observed within the patient group (P =.001).
Conclusion: It is possible that the disruption of exocrine hormone secretion in the pancreas due to the impairment of enteropancreatic
reflexes is secondary to diabetic autonomic neuropathy and resulting in PEI. This study also showed that autonomic neuropathy might
develop and cause PEI in diabetic patients without known added confounding factors.