{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:01:08Z","timestamp":1790773268768,"version":"4.1.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"DON - DNF","award":["2020.10.002"],"award-info":[{"award-number":["2020.10.002"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/hypothesis<\/jats:title>\n                    <jats:p>Although exocrine pancreatic insufficiency (EPI) is thought to be common in type 1 diabetes, little is known about the relationship of EPI with type 1 diabetes parameters or food intake and abdominal complaints. Characterising individuals with EPI could help prevent EPI-related complications such as malabsorption and osteoporosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a cross-sectional cohort of 443 individuals with type 1 diabetes (62% female, median age 42 years [IQR 29\u201354], mean BMI 25\u00b14 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , median diabetes duration 16 years [IQR 6\u201329]), we associated faecal elastase (FE) levels, as a marker of EPI, with type 1 diabetes parameters and clinical features, using linear and Poisson regression models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean FE level (\u00b1SD) was 349.5\u00b1146.8 \u00b5g\/g faeces. A number of variables were independently associated with lower FE levels: older age (\u221210.97 \u00b5g\/g faeces per 10 years; 95% CI \u221221.02, \u22120.92), longer diabetes duration (\u221213.09 \u00b5g\/g per 10 years; 95% CI \u221223.54, \u22122.64), higher HbA\n                      <jats:sub>1c<\/jats:sub>\n                      (\u22121.44 mmol\/mol per 1 SD increase in FE levels, 95% CI \u22122.59, \u22120.30), male sex (\u221254.07 \u00b5g\/g; 95% CI \u221281.41, \u221226.73) and smoking (\u221285.06 \u00b5g\/g; 95% CI \u2212128.52, \u221241.60). In a linear analysis, we found no evidence of associations between FE levels and markers of residual beta cell function, liver disease, macronutrient intakes or gastrointestinal complaints. Using a cut-off of 200 \u00b5g\/g faeces, 76 individuals (17%) were found to have EPI, which was associated with a 4.31 mmol\/mol (0.39%) higher HbA\n                      <jats:sub>1c<\/jats:sub>\n                      (95% CI 1.35, 7.26), an 8% higher mean glucose (95% CI 2, 14), a 9% lower fibre intake (95% CI 1, 17) and an 8% lower energy intake (95% CI 1, 15).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>The lack of evidence for associations with clinical parameters in this relatively healthy population of individuals with type 1 diabetes does not support the use of FE for routine screening for EPI. However, the high prevalence of low FE levels and their association with lower food intake and higher glucose levels justify a need for clinical awareness for EPI and its complications, especially in individuals with long diabetes duration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06829-9","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T16:07:11Z","timestamp":1786205231000},"page":"3221-3231","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High prevalence of low faecal elastase levels in individuals with type 1 diabetes is associated with diabetes duration but not with marked alterations in food intake or clinical symptoms"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-4915","authenticated-orcid":false,"given":"Douwe F.","family":"de Wit","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4166-5045","authenticated-orcid":false,"given":"Coco M.","family":"Fuhri Snethlage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8832-4242","authenticated-orcid":false,"given":"Johannes H. 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Requests for data access may be submitted via the corresponding author and will be considered on a case-by-case basis for research purposes, subject to institutional approval and relevant ethical and regulatory requirements. Data will be made available only to eligible researchers through the Amsterdam UMC formal application mechanism and may be subject to restrictions on use.","order":1,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This research was supported by a DFN DON grant 2020, under which CMFS was appointed. MN is supported by a personal NWO VICI grant 2020 (09150182010020) and an ERC advanced grant (101141346). NMJH is supported by an NWO VIDI grant (09150172210019). The funders of the study had no role in the study design, data collection, data analysis or data interpretation, or writing of the report.","order":2,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"MN is the founder and a scientific advisory board member of Caelus Pharmaceuticals and Advanced Microbiome Interventions (The Netherlands). He is also on the board of directors of Diabeter Netherlands BV.\u00a0NMJH has received honoraria from Boehringer Ingelheim, Bayer and Novo Nordisk paid to his employer. NMJH has received a research grant from Novo Nordisk. None of these interests are relevant to this article. The remaining authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":3,"name":"Ethics","label":"Authors\u2019 relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"DFDW and NMJH drafted the work. ASM, ER, MN and NMJH substantially contributed to the conception and design of the work. CMFS, DFDW and JHML substantially contributed to the acquisition of data. DFDW analysed the data. CMFS, ER, ASM, JHML and MN critically revised it for important intellectual content. All authors approved the final version of the manuscript. NMJH is responsible for the integrity of the work as a whole.","order":4,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}