Diabetes in chronic pancreatitis: risk factors and natural history

Abstract

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.

Post‐pancreatitis diabetes mellitus is common in chronic pancreatitis and is associated with adverse outcomes

“…Therefore, it may be speculated that diabetes in the context of acute pancreatitis is mediated through different mechanisms compared to those involved in the development of diabetes in patients with CP. Generally, in the latter setting, PPDM is interpreted as a function of the duration of pancreatitis, as the increased risk of diabetes over time reflects accumulation of damage to the pancreatic parenchyma caused by chronic inflammation 33 . Since pancreatic calcifications are expression of an chronic inflammatory tissue injury, it is not surprising that our study identified them as an independent predictor of PPDM, which is in line with previous reports (Table 4).…”

“…Indeed, until recently, the extent of PPDM association with PEI was a topic of considerable ambiguity, with reported prevalence of PEI varying between 29% and 64% in CP patients with diabetes 23,30 . However, there is an emerging body of evidence that PEI represents one the risk factors for PPDM, 30,34 which highlights the need to further understand the mechanistic underpinnings of the endocrine‐exocrine interactions of the pancreas 33 …”

“…23,30 However, there is an emerging body of evidence that PEI represents one the risk factors for PPDM, 30,34 which highlights the need to further understand the mechanistic underpinnings of the endocrine-exocrine interactions of the pancreas. 33 Diabetes-related microvascular complications such as neuropathy, nephropathy, and retinopathy are generally thought to occur as frequently in PPDM as in typical type 2 diabetes. 35 However, due to the scarcity of data there is yet no sufficient evidence that would corroborate this hypothesis.…”

Post-pancreatitis diabetes mellitus: insight on optimal management with nutrition and lifestyle approaches

“…Another important aspect when diagnosing a pancreatitis patient with new-onset diabetes is a high suspicion of occult malignancy. Chronic pancreatitis is a risk factor for both diabetes and pancreatic cancer, and new-onset diabetes can be an earlier marker of pancreatic cancer [ 5 , 35 , 36 ]. Thin subjects who are >50 years old at the time of diabetes diagnosis, with sudden weight loss and severe hyperglycaemia are at the highest risk of developing pancreatic cancer, and clinicians should have a low threshold for abdominal imagining (CT or MRI/MRCP) in these patients [ 5 ].…”

Stationäre Patienten mit der Nebendiagnose Diabetes mellitus: klinische Relevanz

“…Bei chronischer Pankreatitis beträgt die Diabetesprävalenz nach 5 Jahren 33 %, bei ca. der Hälfte der Patienten mit Insulinabhängigkeit [ 15 , 18 , 57 ]. Umgekehrt prädisponiert das Vorbestehen eines Diabetes mellitus für die Entwicklung einer akuten Pankreatitis und einen schweren Verlauf [ 49 , 54 ].…”