Role of Pancreatic Shear Wave Elastography in Children with Type 1 Diabetes: A Comparative and Correlative Study with Clinical and Laboratory Parameters

OBJECTIVES: To evaluate pancreatic stiffness in children with type 1 diabetes mellitus (T1DM) using two-dimensional shear wave elastography (2D-SWE), compare findings with age‑matched controls, and assess associations with pancreatic size, clinical parameters, and disease duration. METHODS: Seventy‑six children (38 T1DM, 38 controls) aged 5-18 years underwent standardized pancreatic ultrasound with SWE of the head, body, and tail. Three readings per region were averaged. Pancreatic dimensions, fasting blood sugar (FBS), HbA1c, and clinical details were recorded. Group comparisons and correlation analyses were performed. RESULTS: Children with T1DM showed significantly higher stiffness than controls across all regions (p < 0.001). Mean SWE increased with disease duration: recent‑onset 3.11 ± 1.02 kPa, intermediate 4.72 ± 0.88 kPa, long‑standing 6.29 ± 0.81 kPa; controls 2.85 ± 0.31 kPa. Pancreatic size was smaller in diabetics, with progressive reduction correlating with chronicity. SWE showed a strong positive correlation with disease duration (ρ = 0.823, p < 0.001) and an inverse correlation with pancreatic size. No meaningful association was seen between SWE and HbA1c or FBS. ROC analysis demonstrated good discriminatory performance of pancreatic SWE for differentiating children with T1DM from healthy controls. CONCLUSIONS: Pancreatic stiffness is increased in children with T1DM and rises progressively with disease duration while pancreatic size declines. SWE reflects long‑term structural change rather than short‑term glycaemic status. ADVANCES IN KNOWLEDGE: This study demonstrates that pancreatic SWE provides quantitative measures of pancreatic stiffness and helps elucidate its associations with pancreatic size and disease duration in children with T1DM.