Exocrine Pancreatic Function in Diabetes
The pancreas should be considered as a single endocrine–exocrine gland with complex insulo-acinar-ductal communications. Insulin exerts a trophic and stimulatory effect on the acinar cells, digestive enzymes secreted by the acinar cells are involved in the release of gut-incretin hormones by the enteroendocrine L-cells, and gut-incretin hormones exert a stimulatory effect on insulin release and improve insulin sensitivity. Exocrine pancreatic function is altered in patients with type 1 and type 2 diabetes. Pancreatic atrophy and infiltration of inflammatory cells within the exocrine pancreas may explain reduced pancreatic secretion in type 1 diabetes. The normal structural islet–exocrine interface is lost due to fibrosis in type 2 diabetes. As interstitial fibrosis progresses, the trophic and stimulatory effects of insulin on acinar cells may be impaired and pancreatic enzyme secretion reduced. A low pancreatic enzyme secretion may be associated with gastrointestinal symptoms, and may potentially interfere with the glycemic control in diabetes, but the impact of pancreatic exocrine disturbance in these patients is unclear, and it deserves further investigation.
KeywordsExocrine Diabetes Maldigestion Elastase Incretin
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