Table 2.
Investigation of pancreatic exocrine insufficiency with fecal elastase in type II diabetes patients.
| Studies | Patients | PEI prevalence | Factors associated with PEI | Strengths | Limitations |
|---|---|---|---|---|---|
| Hardt et al. 2003 [16] (cross-sectional study) |
697 | Elastase < 200 = 35.9% Elastase < 100 = 19.9% |
(i) Association with diabetes duration, early onset, and insulin usage (ii) No association with age and sex |
(i) Large cohort of patients (ii) Inclusion and exclusion criteria well designed |
(i) Cross-sectional study without prospective evaluation of patients (ii) Risk factors subgroup analysis not performed in DI and DII patients |
|
| |||||
| Ewald et al. 2007 [17] (cross-sectional study) |
546 | Elastase < 100 = 21.1% | Not investigated | (i) Prospective evaluation of three months of pancreatic enzyme replacement therapy (ii) Well designed study (iii) Large cohort of patients |
(i) Cross-sectional study without prospective evaluation of patients defined (ii) Risk factors analysis for PEI occurrence not performed |
|
| |||||
| Rathmann et al. 2001 [18] (cross-sectional study) |
544 | Elastase < 200 = 30.3% Elastase < 100 = 11.9% |
(i) Association with low BMI and elevated HbA1c (ii) No association with diabetes duration, insulin usage, age, sex, and smoke or alcohol usage |
(i) Extensive analysis of risk factors and clinical features of patients (ii) Specifically performed on type II diabetes patients (iii) Large cohort of patients |
(i) Cross-sectional study without prospective evaluation of patients |
|
| |||||
| Larger et al. 2012 [10] (cross-sectional study) |
472 | Elastase < 200 = 20% Elastase < 100 = 12% |
(i) Association with low BMI and insulin usage (ii) No association with diabetes duration and elevated HbA1c |
(i) Large cohort of patients (ii) Risk factors subgroup analysis performed |
(i) Cross-sectional study without prospective evaluation of patients (ii) Patients with type III diabetes included (iii) Inclusion and exclusion criteria not well specified |
|
| |||||
| Vujasinovic et al. 2013 [13] (cross-sectional study) |
100 | Elastase < 200 = 5% Elastase < 100 = 3% |
(i) No association with diabetes duration | (i) Extensive analysis on PEI-related clinical symptoms (ii) MRI with MRCP performed in all diabetic patients with PEI |
(i) Small number of patients (ii) Enrollment criteria not well-defined (iii) Cross-sectional study without prospective evaluation of patients defined (iv) Poor risk factors analysis |
|
| |||||
| Hardt et al. 2000 [15] (cross-sectional study) |
83 | Elastase < 200 = 46% Elastase < 100 = 16.9% |
(i) Association with GI symptoms (ii) No association with diabetes duration and alcohol usage |
(i) Very small number of patients (ii) Enrollment criteria not well-defined (iii) Cross-sectional study without prospective evaluation of patients defined (iv) No subgroup analysis performed for DI and DII |
|
|
| |||||
|
Mancilla A et al. 2006 [19] (cross-sectional study) |
70 | Elastase < 200 = 33% Elastase < 100 = 19% |
(i) Association with diabetes duration (ii) No association with age, sex, elevated HbA1c, and insulin usage |
(i) Specifically performed on DII patients | (i) Small number of patients (ii) Enrollment criteria not well-defined (iii) Cross-sectional study without prospective evaluation of patients defined (iv) Risk factors not well analyzed (v) Article available only in Spanish |
|
| |||||
| Nunes et al. 2003 [20] (cross-sectional study) |
42 | Elastase < 200 = 36% Elastase < 100 = 22% |
(i) No association with diabetes duration and insulin usage | (i) Case-control study (ii) Patients with PEI underwent US (iii) Specifically performed on DII patients |
(i) Small number of patients (ii) Cross-sectional study without prospective evaluation of patients defined (iii) Risk factors analysis not extensively performed |
|
| |||||
| Yilmaztepe et al. 2005 [21] (cross-sectional study) |
32 | Elastase < 200 = 28.1% Elastase < 100 = 3.1% |
(i) No association with diabetes duration, sex, elevated HbA1c, alcohol usage, and elevated BMI | (i) Specifically performed on DII patients (ii) Case-control study |
(i) Small number of patients (ii) Cross-sectional study without prospective evaluation of patients defined (iii) Risk factors analysis not well-defined |
PEI = pancreatic exocrine insufficiency; US = ultrasound; BMI = body mass index.
DI = type I diabetes; DII = type II diabetes.