1304-P: Exocrine Pancreatic Insufficiency (EPI) Likely Overlooked in Diabetes as Common Cause of Gastrointestinal-Related Symptoms

Background: Exocrine Pancreatic Insufficiency (EPI/PEI) occurs when the pancreas no longer makes enough enzymes to support digestion. Awareness among diabetes care providers does not match the likely rates of prevalence and contributes to underscreening and underdiagnosis of EPI among people with diabetes. Methods: A systematic review of EPI was performed. Resulting articles were analyzed for whether the articles were on diabetes or other co-conditions. Articles on EPI and diabetes were analyzed for type of diabetes, prevalence of EPI reported in diabetes, and publication name. A subsequent literature review of prevalence studies of gastrointestinal conditions in people with diabetes was also performed and data was analyzed to estimate prevalence and compare rates of gastroparesis, celiac, and EPI among people with diabetes. Results: The systematic review of EPI found 644 articles, of which only 40 were focused on EPI and diabetes (12 Type 1, 7 Type 2, 20 both T1/T2 or all types; 1 neonatal). They represent 9.6% of the EPI co-condition literature (n=418) and were published in 29 journals, of which only 9 were diabetes journals. Most were studies on prevalence or diagnosis; whereas one recent article demonstrates a method for evaluating improved glycemic variability following treatment for EPI. The literature review on other GI conditions in people with diabetes found prevalence of 1.3% for gastroparesis, with differing estimates in Type 1 (up to 5% for those who sought care) and Type 2 (1%), and 5% for celiac in Type 1. Prevalence reported for EPI in people with diabetes is higher: estimates vary from 20-50%. Conclusion: Gastroparesis and celiac are often top of mind for diabetes providers, yet EPI/PEI is ~10 times more common among people with diabetes. Healthcare providers who see people with diabetes should increase the screening of fecal elastase (FEL-1) for people with diabetes who mention gastrointestinal symptoms.