Експертний консенсус щодо ведення екзокринної недостатності підшлункової залози у пацієнтів із цукровим діабетом

The objective: to provide a summary of expert recommendations for the early detection and management of pancreatic exocrine insufficiency (PEI) in patients with diabetes mellitus (DM). The publication is based on materials and conclusions of the International Expert Advisory Council, convened on 28 November 2025, which included gastroenterologists and endocrinologists from Ukraine and Israel. The council conducted an analysis of current guidelines and the available evidence regarding the relevance, significance, diagnosis, and treatment of PEI in patients with DM. PEI in the context of DM is a prevalent yet frequently underdiagnosed and underestimated condition. It results in maldigestion, malabsorption, nutritional deficiencies, reduced quality of life, increased glycaemic variability, and worsened long-term prognosis, including elevated cardiovascular risk. In primary care, gastrointestinal symptoms are often incorrectly attributed to adverse effects of antihyperglycaemic therapies such as metformin, GLP-1 agonists, and DPP-4 inhibitors, which can delay accurate diagnosis. Given the combined burden and poor prognosis associated with coexisting PEI and DM, experts recommend proactive screening for PEI in at-risk patients with DM. Risk groups include those with type 1 DM, insulin dependence or low C-peptide levels, type 3c DM, long-standing DM, inadequate glycaemic control, or unexplained weight loss. Recommended screening tools include faecal elastase-1 measurement, the PEI-Q questionnaire, and systematic assessment of nutritional status. Initial pancreatic enzyme replacement therapy should utilise pancreatin in small granules less than 2 mm in diameter (optimally less than 1.8 mm) with enteric coating, at starting doses of 40,000–50,000 units of lipase per main meal and 20,000–25,000 units per snack. Therapy should be long-term, with dose titration based on clinical response and nutritional markers, and should be combined with dietary support and correction of micronutrient deficiencies. Conclusions. PEI in patients with DM represents a clinically significant and frequently underdiagnosed condition in family medicine. The implementation of proactive screening in risk groups, along with a multidisciplinary management approach, is expected to improve quality of life, enhance metabolic control, and reduce long-term adverse prognostic outcomes.