# Exocrine Pancreatic Insufficiency Manifesting Before Insulin Dependence in Adult‐Onset Type 1 Diabetes

## TL;DR

Exocrine pancreatic insufficiency can appear before insulin dependence in adult-onset type 1 diabetes and should be considered in diagnosis and management.

## Contribution

Highlights the under-recognized link between exocrine pancreatic insufficiency and adult-onset type 1 diabetes.

## Key findings

- Exocrine pancreatic insufficiency may precede insulin dependence in adult-onset type 1 diabetes.
- Early recognition and multidisciplinary care improve symptoms and glycemic control.

## Abstract

Exocrine pancreatic insufficiency may precede insulin dependence in adult‐onset type 1 diabetes. Unexplained steatorrhea or weight loss in people with diabetes warrants further investigations including imaging of abdomen/pancreas, exocrine pancreatic function and diabetes antibody testing. Early recognition and multidisciplinary care lead to improvements in symptoms and glycemic control.

Exocrine pancreatic insufficiency as a feature of T1D is commonly overlooked.Clinicians should be aware of this association and include T1D in the list of differential diagnoses in patients with pancreatic insufficiency, in the absence of other pancreatic disease and/or lesions.Patient education on the natural course of T1D, dietician review/advice, continuous glucose monitoring, advice on sick day rules, education/support for self‐management with insulin if hyperglycaemia is noted should be considered in managing such patients with T1D before insulin dependence.

Exocrine pancreatic insufficiency as a feature of T1D is commonly overlooked.

Clinicians should be aware of this association and include T1D in the list of differential diagnoses in patients with pancreatic insufficiency, in the absence of other pancreatic disease and/or lesions.

Patient education on the natural course of T1D, dietician review/advice, continuous glucose monitoring, advice on sick day rules, education/support for self‐management with insulin if hyperglycaemia is noted should be considered in managing such patients with T1D before insulin dependence.

Exocrine Pancreatic Insufficiency Manifesting Before Insulin Dependence in Adult‐Onset Type 1 Diabetes. Unexplained steatorrhea or weight loss in people with diabetes warrants further investigations including imaging of abdomen/pancreas, exocrine pancreatic function and diabetes antibody testing. Early recognition and multidisciplinary care lead to improvements in symptoms and glycemic control.