Does pancreatic elastase-1 in stools predict steatorrhea in type 1 diabetes?

A reduction of exocrine pancreas function frequently occurs in type 1 diabetes (1), and its detection has been made easy by measurement of fecal pancreatic elastase-1 (PE-1) (2,3). We recently observed that PE-1 correlates in these patients with poor blood glucose control, diabetes duration, and residual -cell function (4). A possible consequence of severe pancreatic insufficiency is steatorrhea, defined as a daily fecal fat excretion (FFE) 6 (1) or 7 (5) g/day for subjects consuming 100 g of fat per day (1,5,6). Testing FFE requires multiple daily stool collections (6) and is not routinely feasible in asymptomatic subjects, being poorly accepted by patients and disliked by laboratory technicians. We considered here the hypothesis that low PE-1 identifies patients to be submitted to FFE measurement for steatorrhea detection.