Chronic pancreatitis and diabetes mellitus: a review of the literature

Background: For a long time there has been a discussion about how chronic pancreatitis (CP) and diabetes mellitus (DM) are related to each other. If a patient has both conditions, should they be viewed as two separate disorders, or one of them is a plausible consequence of the other? If the latter is true, what are pathophysiological mechanisms of DM in CP? Current consensus documents by specialists in pancreatic diseases pay little attention to this issue, and their main statements have low level of evidence. The Russian consensus on the diagnosis and treatment of CP (2016) contains no statements on DM. In the Russian guidelines and consensus documents to be developed, it is necessary to include provisions on the pancreatogenic DM as an independent “other type DM’, with consideration of its pathophysiological mechanisms and clinical particulars.Aim: To characterize the state-of-the-art in pancreatogenic DM, to demonstrate its differences from DM types 1 and 2 from pathogenetic and clinical perspectives.Methods: The review is based on the results of meta-analyses, systematic reviews and main provisions of the existing clinical guidelines and consensus documents available from PubMed and E-library.Results: According to various sources, Type 3c DM, or latent impaired glucose tolerance in CP, can eventually develop in 25 to 80% patients with CP. Impaired glucose tolerance is found in 40 to 60% of patients with acute pancreatitis, with persistent hyperglycemia after acute episode seen in 15 to 18% of the patients. Exocrine pancreatic insufficiency is commonly seen in Type 1 and Type 2 diabetic patients, although the data on its prevalence are highly contradictory indicating a lack of knowledge in the field. Type 3c DM is characterized by its manifestation at later stages of CP, concomitant excretory deficiency of the pancreas, brittle course with proneness to hypoglycemia and no ketoacidosis. The highest risk group includes patients with longstanding CP, previous partial pancreatic resection and patients with early calcifying pancreatitis, mainly of the alcoholic origin. Optimal and rational medical treatment of pancreatogenic DM still remains disputable, while the evidence base of the efficacy and safety of various anti-diabetic agents in this disease is lacking, and no consensus on the issue has been yet reached. General treatment guidelines given in a number of international consensus documents are limited to cautious insulin administration.Conclusion: Pancreatogenic DM differs from Type 1 and Type 2 DM in a number of aspects, namely, mechanisms of hyperglycemia, hormonal profiles, clinical particulars and treatment approaches. Endocrine pancreatic insufficiency in CP is caused by secondary inflammatory injury of the pancreatic islets. The key to specifics of Type 3c DM lies in anatomical and physiological interplay of the exocrine and endocrine compartments of the pancreas. At presents, most provisions on pancreatogenic DM are empirical and seem to be rather declarative, because intrinsic mechanisms of this type of diabetes and moreover its pathogenetically based treatment have been poorly studied. Nevertheless, all patients with CP or other pancreatic diseases should be assessed for pancreatogenic DM.

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Diabetes in pregnancy

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0013 ◽

2020 ◽

pp. 163-169

Author(s):

Michael Permezel ◽

Alexis Shub

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Obese Women ◽

Diabetes In Pregnancy ◽

Clinically Significant ◽

In Pregnancy

The importance of diabetes in pregnancy arises through two unrelated phenomena: an increased predisposition to impaired glucose tolerance in late pregnancy and an adverse impact of the increased glucose on important obstetric outcomes. There are marked differences in clinical outcomes and management between pregnancies in which a clinically significant impairment of glucose tolerance was first noticed during pregnancy (‘gestational diabetes mellitus’) and those where type 1 or type 2 diabetes mellitus had been known prior to pregnancy (‘prepregnancy diabetes’). Historically, GDM has been defined as the diagnosis of clinically significant impaired glucose tolerance in pregnancy in a woman not previously known to be diabetic. This has recently been complicated by recognizing that some diabetes mellitus will present for the first time in pregnancy and lack of clarity as to where the lower threshold for diagnosis should best be placed. Type 1 diabetes is present in approximately 0.2% of pregnant women, and the numbers are largely stable. In contrast, type 2 diabetes was once uncommon in pregnancy but is now also as high as 0.2%. This is likely to continue to increase as increased numbers of overweight and obese women enter the reproductive years. Prepregnancy diabetes provides the model of how pregnancy and maternal disease impact on each other, and how good preconception, antenatal and intrapartum care can make an enormous difference for these women and their babies.

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Faculty Opinions recommendation of Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733293123.793567383 ◽

2019 ◽

Author(s):

Chris Forsmark

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency

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Plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus and impaired glucose tolerance

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2006.07.031 ◽

2007 ◽

Vol 76 (1) ◽

pp. 24-29 ◽

Cited By ~ 103

Author(s):

Teoman Dogru ◽

Alper Sonmez ◽

Ilker Tasci ◽

Ergun Bozoglu ◽

Mahmut Ilker Yilmaz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Newly Diagnosed

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Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients

Diabetologia ◽

10.1007/s00125-011-2380-5 ◽

2011 ◽

Vol 55 (5) ◽

pp. 1273-1282 ◽

Cited By ~ 63

Author(s):

J.-W. van Dijk ◽

R. J. F. Manders ◽

K. Tummers ◽

A. G. Bonomi ◽

C. D. A. Stehouwer ◽

...

Keyword(s):

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

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Prevalence of newly diagnosed prediabetes, diabetes mellitus among the officers from Phuoc Long district of Binh Phuoc province

Vietnam Journal of Diabetes and Endocrinology ◽

10.47122/vjde.2020.40.4 ◽

2021 ◽

pp. 24-28

Author(s):

Thanh Long Le ◽

Trung Vinh Hoang

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Impaired Fasting Glucose ◽

Fasting Glucose ◽

Newly Diagnosed ◽

Personal Communications

Objective: To evaluate the prevalence of newly diagnosed prediabetes, diabetes mellitus among the officers from Phuoc Long district of Binh Phuoc province. Subjects and methods: 268 personals communications service was examined the impaired fasting glucose (G0); impaired glucose tolerance (G2) anh HbA1c. Results: Prevalence of prediabetes, type 2 diabetes mellitus by G0, G2, HbA1c as follows 16,0%; 13,1%; 17,9% and 3,8%; 6,7%; 2,2%. Common prevalence of prediabetes in 26,9%; type 2 diabetes mellitus in 7,1%. Conclusion: Personal communications service from Phuoc Long district have percentage of prediabetes higher compared to type 2 diabetes mellitus which of prediabetes was diagnosed by HbA1c which takes up the highest percentage; diabetes mellitus was diagnosed by G2which takes up the highest percentage.

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Autoimmune Pancreatitis

10.2310/gastro.5467 ◽

2018 ◽

Author(s):

Allison L Yang ◽

Julia McNabb-Baltar

Keyword(s):

Chronic Pancreatitis ◽

Obstructive Jaundice ◽

Autoimmune Pancreatitis ◽

Pancreatic Insufficiency ◽

Imaging Findings ◽

Laboratory Findings ◽

Related Disease

Autoimmune pancreatitis (AIP) is a subcategory of chronic pancreatitis that is highly responsive to steroids. The term was first proposed in 1995 by Yoshida and colleagues, and since its discovery, the diagnosis of AIP has dramatically increased. AIP is a chronic fibroinflammatory disease characterized by lymphoplasmacytic infiltrates and fibrosis on histology. There are two distinct subtypes: type 1 AIP is the pancreatic manifestation of a systemic serum immunoglobulin G subtype 4–related disease (IgG4-RD) and type 2 AIP is described clinically as idiopathic duct-centric pancreatitis and has no association with IgG4. Clinically, AIP presents most commonly as obstructive jaundice in type 1 AIP and can present as acute pancreatitis in type 2 AIP. The diagnostic criteria include histology, imaging findings, and responsiveness to steroids as well as laboratory findings and other organ involvement. The mainstay of treatment is steroid therapy, with immunomodulators such as rituximab used for maintenance or relapsing disease. Long-term complications of AIP include pancreatic insufficiency and are often associated with relapsing disease. This review contains 45 references, 1 figure, and 2 tables. Key Words: autoimmune pancreatitis, chronic pancreatitis, EUS-guided biopsy, IgG4, immunomodulatory, obstructive jaundice, pancreas mass, steroid

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Diabetes mellitus and impaired glucose tolerance in urban adult population

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.60.02.008 ◽

2014 ◽

Vol 60 (2) ◽

pp. 118-124 ◽

Cited By ~ 3

Author(s):

Walter Rodrigues Júnior ◽

Sandra Cristina Nicodemo Gaban ◽

Elenir Rose Jardim Cury Pontes ◽

Celso Correia Souza ◽

Lilian Patussi Gimenes ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Adult Population ◽

Oral Glucose ◽

Diabetic Patients ◽

Mato Grosso ◽

Strict Adherence ◽

Family History Of Diabetes

Objective: Estimating the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the urban population aged between 30 and 69 years in the municipality of Campo Grande, state of Mato Grosso do Sul, Brazil. Methods: Population-based cross-sectional study conducted between October/2009 and February/2011. The investigation included the determination of fasting glucose and participants with blood glucose ≥ 200 mg/dL were considered diabetic. Nondiabetic patients, which showed blood glucose ≥ 100 mg/dL and < 200 mg/dL, underwent an oral glucose tolerance test (OGTT) to investigate whether they had DM or IGT. Results: 1.429 individuals participated in this investigation. The general prevalence, adjusted for sex and age, were: 12.3% for DM (95%CI: 10.5 to 13.9%) and 7.1% for IGT (95%CI: 5.7 to 8.4%). There was a higher prevalence of DM with increasing age in people with low educational level, family history of diabetes, overweight, obesity and central obesity. Among diabetic patients (n = 195), 25% were unaware they had the disease and were diagnosed through investigation. Among patients who already knew they had DM (n = 146), 37% were unaware of the potential chronic complications. Conclusion: This study confirms the increased prevalence of DM in Brazil and emphasizes the need for early diagnosis, as well as the importance of strict adherence to medical treatment in order to prevent its much feared complications.

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Relationship of Soluble RAGE and RAGE Ligands HMGB1 and EN-RAGE to Endothelial Dysfunction in Type 1 and Type 2 Diabetes Mellitus

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0031-1283161 ◽

2012 ◽

Vol 120 (05) ◽

pp. 277-281 ◽

Cited By ~ 39

Author(s):

J. Škrha Jr ◽

M. Kalousová ◽

J. Švarcová ◽

A. Muravská ◽

J. Kvasnička ◽

...

Keyword(s):

Diabetes Mellitus ◽

Endothelial Dysfunction ◽

Advanced Glycation Endproducts ◽

Vascular Complications ◽

Diabetic Patients ◽

Glycation Endproducts ◽

Diabetic Vascular Complications ◽

Soluble Rage

AbstractReceptor for advanced glycation endproducts (RAGE) plays the essential role in the pathogenesis of diabetic vascular complications. The aim of the study was to compare concentration of soluble RAGE and its ligands (EN-RAGE and HMGB1) with different biochemical parameters in Type 1 (T1DM) and Type 2 (T2DM) diabetes mellitus.Total number of 154 persons (45 T1DM, 68 T2DM, 41 controls) was examined and concentrations of sRAGE, EN-RAGE and HMGB1 were measured and compared to diabetes control, albuminuria, cell adhesion molecules and metalloproteinases (MMPs).Mean serum sRAGE concentration was higher in T1DM as compared to controls (1137±532 ng/l vs. 824±309 ng/l, p<0.01). Similarly, EN-RAGE was significantly higher in both diabetic groups (p<0.001) and HMGB1 concentrations were elevated in T2DM patients (p<0.01). Significant relationship was found between MMP9 and HMGB1 and EN-RAGE in diabetic patients. Inverse relationship was observed between MMP2 and MMP9 in both types of diabetic patients (r= − 0.602, p<0.002 and r= − 0.771, p<0.001). Significant positive correlation was found between sRAGE and ICAM-1, VCAM-1 or vWF (p<0.01 to p<0.001).We conclude that serum sRAGE and RAGE ligands concentrations reflect endothelial dysfunction developing in diabetes.

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