Risk factors for development of endocrine insufficiency in chronic pancreatitis

Aslam, Mohsin; Jagtap, Nitin; Karyampudi, Arun; Talukdar, Rupjyoti; Reddy, D. Nageshwar

doi:10.1016/j.pan.2020.11.011

Cited by 16 publications

(7 citation statements)

References 56 publications

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“…On the other hand, smoking was not a risk factor for diabetes among 1633 individuals with idiopathic chronic pancreatitis [8 ▪▪ ]. In another study, smoking and alcohol use were associated with incident diabetes in univariable analysis but were not significant independent factors in multivariable analysis [9 ▪ ].…”

Section: Risk Factors For Diabetes In Chronic Pancreatitismentioning

confidence: 95%

“…Similar to the studies described above, among 1287 individuals with chronic pancreatitis, diabetes was more frequent in those with adult onset chronic pancreatitis compared with childhood onset [2]. Among 587 consecutive chronic pancreatitis individuals (excluding any who had had pancreatic surgery) followed for a median of 10 years (20% incident diabetes), independent risk factors for development of diabetes were EPI (OR 6.29), pancreatic duct stricture (OR 3.36), presence of ductal (OR 2.35) or parenchymal (OR 2.28) calcifications, and older age (OR 1.08) [9 ▪ ]. Pancreatic duct calcification and tobacco smoking were independent factors associated with earlier onset of diabetes.…”

Section: Risk Factors For Diabetes In Chronic Pancreatitismentioning

confidence: 99%

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Diabetes in chronic pancreatitis: risk factors and natural history

Goodarzi¹,

Petrov

Andersen

et al. 2021

Current Opinion in Gastroenterology

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Purpose of review The purpose of this review is to delineate risk factors for the development of diabetes in patients with chronic pancreatitis. The natural history including progression to diabetes and complications that develop once diabetes occurs in chronic pancreatitis is also reviewed. Recent findings Studies have found that predictors of diabetes in chronic pancreatitis include both risk factors for type 2 diabetes (e.g., obesity, genetic variants) as well as pancreas-specific factors (e.g., pancreatic calcification, exocrine insufficiency). Rates of diabetes in chronic pancreatitis are strongly related to the duration of chronic pancreatitis, reflecting progressive dysfunction and damage to the insulin-secreting beta cells. Patients with diabetes and chronic pancreatitis experience an excess burden of complications, including higher all-cause and cancer-related mortality. Summary The high incidence and significant impact of diabetes on the morbidity and mortality of patients with chronic pancreatitis highlights the urgent need for clinically applicable models to predict diabetes in those with chronic pancreatitis, allowing efforts for targeted interventions to prevent diabetes. Research being carried out in the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer holds promise to fulfill these goals.

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Section: Risk Factors For Diabetes In Chronic Pancreatitismentioning

confidence: 95%

Section: Risk Factors For Diabetes In Chronic Pancreatitismentioning

confidence: 99%

Diabetes in chronic pancreatitis: risk factors and natural history

Goodarzi¹,

Petrov

Andersen

et al. 2021

Current Opinion in Gastroenterology

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“…For example, loss of alpha cells in islets leads to impaired secretion of glucagon and compromise glucose counter-regulation to hypoglycemia, which may explain the high prevalence of hypoglycemia observed in patients with diabetes and chronic pancreatitis [7]. In these patients, the risk of hypoglycemia may also be exacerbated by severe malnutrition and depleted glycogen stores, owing to intestinal malabsorption of nutrients caused by exocrine pancreatic insufficiency, and altered dietary intake [4,5 ▪ ,26,27]. Chronic pancreatitis has also been associated with a blunted incretin secretion during oral feeding, which is only partly reversed by pancreatic enzyme replacement therapy [28,29].…”

Section: The Spectrum Of Diabetes In Pancreatitismentioning

confidence: 99%

The spectrum of diabetes in acute and chronic pancreatitis

Olesen

Toledo

Hart

2022

Current Opinion in Gastroenterology

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Purpose of reviewTo discuss the spectrum of diabetes related to acute and chronic pancreatitis (which are types of pancreatogenic diabetes) and its overlapping features with type 1 and type 2 diabetes.Recent findingsPatients with diabetes related to acute and chronic pancreatitis present clinically within a spectrum of overlapping features with other forms of diabetes. In this spectrum, glucose metabolism alterations range from increased insulin resistance following acute pancreatitis (resembling type 2 diabetes) towards a permanent loss of beta-cell function and impaired insulin secretion in end-stage chronic pancreatitis. Overlapping features with type 1 diabetes (beta cell autoantibodies) and type 2 diabetes (obesity, dyslipidemia, and hereditary/genetic factors) contribute to the heterogeneity of this spectrum.SummaryPancreatogenic diabetes secondary to acute or chronic pancreatitis is a heterogeneous entity with a variable clinical presentation, including many cases that are misdiagnosed and treated as type 2 diabetes. This is problematic as pancreatogenic diabetes is associated with a poor prognosis and entails special considerations for management. Recent discoveries showing overlapping features with type 1 and type 2 diabetes along with an improved understanding of its pathophysiology are expected to improve the diagnosis and treatment of these and other forms of pancreatogenic diabetes.

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“…Both the pediatric and adult guidelines recommend screening for EPI and DM (specifically type 3c, T3cDM) yearly and starting individuals with EPI on pancreatic enzyme replacement therapy (PERT) with the guidance of an RDN (44)(45)(46)(47). Failure to diagnose and treat young individuals with EPI and DM can result in growth delay or failure.…”

Section: Special Management Concerns In Young Adultsmentioning

confidence: 99%

Pediatric-to-Adult Transfer of Care in Patients With Pancreas Disease: Recommendations for Care and Research Opportunities

et al. 2022

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Young adults who have experienced recurrent acute pancreatitis and chronic pancreatitis as children or adolescents are vulnerable to poor follow-up and disease management during the transfer from the pediatric to adult healthcare system. Although formalized transition programs for young adults have been developed and described for other disease conditions, no such program has been described for young adults with pancreatic disease. This document is the first expert opinion outlining the important aspects of a transitional care and transfer program tailored to youth with recurrent acute and chronic pancreatitis. We emphasize the unique needs of these patients as they transfer to adult health care and the need for further research. The goal of improved transitional care and transfer is to enhance the services provided to adolescents/young adults with pancreatic disease in both healthcare settings and improve continuity of follow-up care.

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Risk factors for development of endocrine insufficiency in chronic pancreatitis

Cited by 16 publications

References 56 publications

Diabetes in chronic pancreatitis: risk factors and natural history

Diabetes in chronic pancreatitis: risk factors and natural history

The spectrum of diabetes in acute and chronic pancreatitis

Pediatric-to-Adult Transfer of Care in Patients With Pancreas Disease: Recommendations for Care and Research Opportunities

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