DIAGNOSIS OF ENDOCRINE DISEASE: Post-pancreatitis diabetes mellitus: prime time for secondary disease

Abstract

While most people with diabetes have type 2 disease, a non-negligible minority develops a secondary diabetes. Post-pancreatitis diabetes mellitus (PPDM) is an exemplar secondary diabetes that represents a sequela of pancreatitis - the most common disease of the exocrine pancreas. Although this type of diabetes has been known as a clinical entity since the late 19th century, early 21st century high-quality epidemiological, clinical, and translational studies from around the world have amassed a sizeable body of knowledge that have led to a renewed understanding of PPDM. People have at least two-fold higher lifetime risk of developing diabetes after an attack of pancreatitis than those in the general population without history of diseases of the exocrine pancreas. PPDM is caused by acute pancreatitis (including non-necrotising pancreatitis, which constitutes the majority of acute pancreatitis) in four-fifth of cases and chronic pancreatitis in one-fifth of cases. Moreover, the frequency of incident diabetes is not considerably lower after acute pancreatitis than after chronic pancreatitis. Recurrent attacks of pancreatitis and exocrine pancreatic dysfunction portend high risk for PPDM, but are not mandatory for its development. Further, young- or middle-aged non-obese men have an increased risk of developing PPDM. In comparison with type 2 diabetes, PPDM is characterised by poorer glycaemic control, higher risk of developing cancer (in particular, pancreatic cancer), younger age at death, and higher risk of mortality. Metformin monotherapy is recommended as first-line therapy for PPDM. Appropriate screening of individuals after an attack of pancreatitis, correct identification of PPDM, and apposite management is crucial with a view to improving the outcomes of this secondary but not inappreciable disease.

Post-pancreatitis diabetes mellitus and excess intra-pancreatic fat deposition as harbingers of pancreatic cancer

“…, PPDM). PPDM is a sub-type of diabetes of the exocrine pancreas and is caused by acute pancreatitis in four out of five people and chronic pancreatitis in one out of five people[ 12 ]. Its epidemiology, risk factors, pathogenesis, and management were comprehensively reviewed elsewhere[ 12 ].…”

“…PPDM is a sub-type of diabetes of the exocrine pancreas and is caused by acute pancreatitis in four out of five people and chronic pancreatitis in one out of five people[ 12 ]. Its epidemiology, risk factors, pathogenesis, and management were comprehensively reviewed elsewhere[ 12 ]. A large 2020 cohort study by Cho et al [ 13 ] compared the risks of developing pancreatic cancer in PPDM vs type 2 diabetes mellitus without history of pancreatitis and showed that PPDM was associated with a 7-times significantly higher risk for pancreatic cancer (adjusted hazard ratio 6.94; 95% confidence interval 4.09 to 11.77).…”

Dietary Fibre Intake in Type 2 and New-Onset Prediabetes/Diabetes after Acute Pancreatitis: A Nested Cross-Sectional Study

“…Participants who were normoglycaemic before and during attack of AP and had follow-up HbA1c ≥ 5.7% (39 mmol/mol) and/or FPG ≥ 100 mg/dL (5.6 mmol/L) after hospital discharge constituted the NODAP group. Only participants who met the above criteria at more than three months after hospitalisation for AP were included in the NODAP group, in line with the published recommendations [1,2,29].…”

“…Post-pancreatitis diabetes mellitus, which is a subtype of diabetes of the exocrine pancreas, is the most frequent sequela of acute pancreatitis (AP) [1,2]. Epidemiological evidence showed that individuals with a history of AP are at more than two-times higher risk of developing diabetes mellitus when compared with the general population [3,4].…”

“…In addition, intake of dietary fibre from common food sources was investigated in several prospective studies, which suggested that a dietary pattern with a high consumption of fruit and vegetables [17][18][19][20], legumes [21,22], and cereals [16,23,24] was associated with reduced risk of Type 2 diabetes. While in the past it was thought that only extensive pancreatic necrosis or chronic inflammation of the pancreas (resulting in β-cell destruction) can lead to the development of new-onset diabetes, several recent studies have consistently shown that glucose derangements can also develop after an attack of mild acute pancreatitis (driven by insulin resistance) [2,[25][26][27]. However, to date, dietary fibre intake has never been investigated specifically in the context of NODAP.…”