According to a review published in April 2020 in the journal Current Diabetes Reports, type 1 and type 2 diabetes commonly occur with mild to moderate EPI. One study cited in this review — which was itself a meta-analysis — found that EPI was reported in nearly 39 percent of patients with type 1 diabetes and more than 28 percent in those with type 2 diabetes. While researchers aren’t entirely surely why diabetes can lead to EPI, it’s thought that, in case of type 1 diabetes, the pancreas cells that produce digestive enzymes can become damaged, according to research. The reverse is also true: If you have EPI, you could also be at risk for diabetes. In people who have EPI, the pancreas either isn’t able to produce enough of the enzymes the body needs to break down food in the digestive tract or is blocked, meaning the enzymes that are produced aren’t able to reach the digestive tract. A blockage in the pancreas can also cause partial digestion of the pancreatic tissue itself, which in turn can damage the cells that produce insulin, a hormone that helps regulate blood sugar levels. There’s more to the link between diabetes and EPI than proximity, but researchers aren’t exactly sure what it is — although it sounds a lot like the riddle of the chicken and the egg. “Diabetes can be caused by exocrine disease, and exocrine pancreatic insufficiency can be caused by diabetes,” explains Philip D. Hardt, a physician and researcher with the University Hospital of Giessen and Marburg in Giessen, Germany, and author of an article on this topic. “Both are possible.”
Diabetes damages pancreatic tissue. Some evidence has shown greater-than-normal amounts of inflammation and damage to pancreatic tissue, suggesting that having diabetes could increase the risk for EPI. “People with diabetes have a much greater risk for acute pancreatitis [sudden inflammation of the pancreas] compared to those without diabetes,” says endocrinologist Rita Rastogi Kalyani, MD, MHS, an associate professor of medicine at Johns Hopkins University in Baltimore and editor-in-chief of the Johns Hopkins Diabetes Guide.Pancreatitis causes diabetes. People who have a bout of acute pancreatitis appear to be at an increased risk for diabetes later on, Dr. Kalyani says, and people with chronic pancreatitis (or long-term inflammation of the pancreas) can also have diabetes. Other pancreatic diseases, such as cystic fibrosis and pancreatic cancer, are also associated with diabetes.Both share autoimmune links. In a small number of people, autoimmune dysfunction could cause the development of both pancreatitis and diabetes, according to Dr. Hardt’s report. This area of research is still being explored.Complications of diabetes may lead to EPI. Diabetic neuropathy, a serious complication of diabetes involving nerve damage, may interfere with the signaling of pancreatic cells and neurons that carry out exocrine functions, according to Hardt’s research.
Research into all these connections needs to be expanded, Hardt says.
Signs and Symptoms of EPI
If you have diabetes, these are the signs and symptoms of EPI to be aware of:
Abdominal pain that can be either mild or severeSteatorrhea, or fatty, oily stools — a sign that pancreatic enzymes aren’t getting to your digestive tract to break down fats in the food you eatWeight lossBrittle (labile or unstable) diabetes: Some people with type 1 diabetes find that their blood sugar is extremely hard to control, possibly because the body is digesting carbohydrates poorly or a damaged or inflamed pancreas is undermining their best efforts, Kalyani says.
Although these are some of the most common signs of EPI, these symptoms can have other causes as well. In fact, many people with diabetes complain of general stomach problems that don’t necessarily indicate an emergency health situation. Kalyani says that if these are new symptoms for you, you should see your doctor promptly. Additional reporting by Katherine Lee
