Age- and sex-specific prevalence of diabetes associated with diseases of the exocrine pancreas: A population-based study

Pendharkar, Sayali A.; Mathew, Juby; Petrov, Maxim S.

doi:10.1016/j.dld.2016.12.010

Cited by 106 publications

(83 citation statements)

References 32 publications

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“…described previously, AP was the most common pancreatic disease preceding diabetes . There was a high proportion of AP (61%) causing DEP in a study of the New Zealand population, which demonstrated an overall prevalence of 1.13 per 1000 population . A large systematic review and meta‐analysis revealed the high incidence (15%) of DEP in the first year following AP, increasing further (23%) at 5 years …”

Section: Screeningmentioning

confidence: 83%

“…4 There was a high proportion of AP (61%) causing DEP in a study of the New Zealand population, which demonstrated an overall prevalence of 1.13 per 1000 population. 28 A large systematic review and meta-analysis revealed the high incidence (15%) of DEP in the first year following AP, increasing further (23%) at 5 years. 41 Patients with other conditions commonly associated with DEP, such as CF, 42 hereditary hemochromatosis, and transfusion overload due to, for example, thalassemia major, 43 should also be screened for DEP.…”

Section: Screeningmentioning

confidence: 99%

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Diabetes of the exocrine pancreas

Wynne

Devereaux

Dornhorst

2018

J of Gastro and Hepatol

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Diabetes of the exocrine pancreas (DEP) is a form of diabetes that occurs due to pancreatic disease. It is far more common than has been previously considered, with a recent study showing 1.8% of adults with new-onset diabetes should have been classified as DEP. The majority is misdiagnosed as type 2 diabetes mellitus (T2DM). Patients with DEP exhibit varying degrees of exocrine and endocrine dysfunction. Damage to the islet of Langerhans effects the secretion of hormones from the β, α, and pancreatic polypeptide cells; the combination of low insulin, glucagon, and pancreatic polypeptide contributes to rapid fluctuations in glucose levels. This form of "brittle diabetes" may result in the poorer glycemic control observed in patients with DEP, when compared with those with T2DM. Diabetes of the exocrine pancreas has a different natural history to other forms of diabetes; patients are more likely to require early insulin initiation compared with those with T2DM. Therefore, individuals with DEP should be advised about the symptoms of decompensated hyperglycemia, although they are less likely to develop ketoacidosis. Clinicians should screen for DEP in patients with acute or chronic pancreatitis, following pancreatic resection, or with co-existing cystic fibrosis or hemochromatosis. Incident diabetes may herald the onset of pancreatic ductal carcinoma in a small subset of patients. Once identified, patients with DEP can benefit from specific lifestyle advice, pancreatic enzyme replacement therapy, metformin treatment, appropriate insulin dosing, and monitoring. Further research is needed to establish the ideal treatment regimens to provide optimal clinical outcomes for this unique form of diabetes.

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Section: Screeningmentioning

confidence: 83%

Section: Screeningmentioning

confidence: 99%

Diabetes of the exocrine pancreas

Wynne

Devereaux

Dornhorst

2018

J of Gastro and Hepatol

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“…Carefully designed modelling studies on hypothetical changes in lifestyle risk factors at the population-level are warranted to examine the interactions between smoking, alcohol (and metabolic conditions such adiposity and diabetes [51,52]) and their impact on burden of pancreatic cancer. Such studies will need to be large enough to detect multiplicative interaction between tobacco, alcohol (and metabolic factors) and have sufficient number of cases for pancreatic cancer in each permutation risk factors.…”

Section: Present Challenges and Future Directionsmentioning

confidence: 99%

Tobacco and alcohol as risk factors for pancreatic cancer

Korc

Jeon

Edderkaoui

et al. 2017

Best Practice & Research Clinical Gastroenterology

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Pancreatic cancer is projected to become the leading cause of cancer deaths by 2050. The risk for pancreatic cancer may be reduced by up to 27% by modifying lifestyle risk factors, most notably tobacco smoking. Based on analysis of more than 2 million unselected individuals from general population, this article quantified the risk of pancreatic cancer in relation to lifelong tobacco smoking and alcohol consumption status, both alone and in combination. It also provided a state-of-the-art review of animal studies on the effect of tobacco smoke and alcohol on genetically engineered mouse models of pancreatic precursor lesions, as well as the role of pancreatic stellate cells and immune cells in pancreatic carcinogenesis activated by tobacco and alcohol.

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“…While its statistics were, until recently, largely confined to chronic pancreatitis and pancreatic cancer (3,4), emerging large scale population-based studies show that more than 60% of all cases of diabetes of the exocrine pancreas are due to new-onset diabetes after acute pancreatitis (NODAP) (5)(6)(7), and that the risk of NODAP may not depend on severity of acute pancreatitis (8,9). However, the molecular mechanisms underlying the pathophysiology of NODAP remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Calcitonin gene-related peptide: neuroendocrine communication between the pancreas, gut, and brain in regulation of blood glucose

et al. 2017

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Background: Calcitonin gene-related peptide (CGRP), a ubiquitous neuropeptide, plays a diverse and intricate role in chronic low-grade inflammation, including conditions such as obesity, type 2 diabetes, and diabetes of the exocrine pancreas. Diabetes of exocrine pancreas is characterised by chronic hyperglycemia and is associated with persistent low-grade inflammation and altered secretion of certain pancreatic and gut hormones. While CGRP may regulate glucose homeostasis and the secretion of pancreatic and gut hormones, its role in chronic hyperglycemia after acute pancreatitis (CHAP) is not known. The aim of this study was to investigate the association between CGRP and CHAP.Methods: Fasting blood samples were collected to measure insulin, HbA1c, CGRP, amylin, C-peptide, glucagon, pancreatic polypeptide (PP), somatostatin, gastric inhibitory peptide, glicentin, glucagon-like peptide-1 and 2, and oxyntomodulin. Modified Poisson regression analysis and linear regression analyses were conducted. Five statistical models were used to adjust for demographic, metabolic, and pancreatitisrelated risk factors.Results: A total of 83 patients were recruited. CGRP was significantly associated with CHAP in all five models (P-trend <0.005). Further, it was significantly associated with oxyntomodulin (P<0.005) and glucagon (P<0.030). Oxyntomodulin and glucagon independently contributed 9.7% and 7%, respectively, to circulating CGRP variance. Other pancreatic and gut hormones were not significantly associated with CGRP.Conclusions: CGRP is involved in regulation of blood glucose in individuals after acute pancreatitis. This may have translational implications in prevention and treatment of diabetes of the exocrine pancreas.

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Age- and sex-specific prevalence of diabetes associated with diseases of the exocrine pancreas: A population-based study

Cited by 106 publications

References 32 publications

Diabetes of the exocrine pancreas

Diabetes of the exocrine pancreas

Tobacco and alcohol as risk factors for pancreatic cancer

Calcitonin gene-related peptide: neuroendocrine communication between the pancreas, gut, and brain in regulation of blood glucose

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