Metabolic dysfunction and diabetes mellitus during long-term follow-up of severe acute pancreatitis: A case-matched study

Duggan, Sinead N.; O’Connor, Donal B; Antanaitis, Andrius; Campion, John R.; Lawal, Oladapo; Ahmed, Mohamed; Rakovac, Ana; Sherlock, Mark; Boran, Gerard; Roux, Carel W. le; Gibney, James; Conlon, Kevin C.

doi:10.1016/j.pan.2020.03.016

Cited by 12 publications

(11 citation statements)

References 33 publications

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“…Several studies have attempted to compare the two methods. Minimally invasive approaches appear to have, in comparison with open necrosectomy, lower rates of pancreatic fistula formation, early postprocedural organ dysfunction, mortality, and long-term complications, such as hernias, exocrine pancreatic insufficiency, and use of antidiabetic medication [69,75,76]. On the other hand, minimally invasive procedures have been criticized, as they often require repeated debridement attempts prior to resolution, prolonging the inpatient stay [63,64,69,75,76].…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Pancreatitis: Conservative Treatment and Step-Up Invasive Approaches—Evidence-Based Guidance for Clinicians

et al. 2022

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Although acute pancreatitis is one of the most common conditions that physicians face in daily practice, different approaches are still being followed. Given that in 20–30% of cases, acute pancreatitis progresses to the severe form with single- or multiorgan failure and is often associated with admission to the intensive care unit, proper management is important. This article is aimed at emphasizing the importance of proper conservative treatment of acute pancreatitis and at focusing on intervention criteria in case of complications, analyzing additionally the step-up endoscopic and surgical approaches. The most common mistakes in conservative treatment include inadequate initial fluid resuscitation, abuse in the administration of antibiotics, insufficient analgesia, avoidance of oral feeding, and inappropriate use of imaging techniques. Moreover, the timing and indications for endoscopic retrograde cholangiopancreatography and cholecystectomy are crucial. Furthermore, in case of unsatisfying response to conservative treatment, which mainly happens during necrotic pancreatitis, early intervention is not indicated and a minimally invasive approach must be adopted firstly, 4 weeks after the onset of the disease, and before any surgical intervention. Each medical procedure has specific indications and must be used in the appropriate occasion. As a result, clinical doctors must be familiar both with the intervention criteria and the indications of each method. The proper management of acute pancreatitis is essential and life-saving. That is valid both for the conservative treatment and for the invasive approaches.

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Section: Discussionmentioning

confidence: 99%

Management of Acute Pancreatitis: Conservative Treatment and Step-Up Invasive Approaches—Evidence-Based Guidance for Clinicians

et al. 2022

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“…In support of this model, small studies have reported lower stimulated circulating C-peptide and insulin levels in individuals who recovered from severe AP 3,4 . Another study reported lower insulin secretion in DM after AP compared with DM without AP 5 . While islet loss during the AP episode is one mechanism by which AP may cause DM, other pathways might be involved.…”

mentioning

confidence: 86%

“…3,4 Another study reported lower insulin secretion in DM after AP compared with DM without AP. 5 While islet loss during the AP episode is one mechanism by which AP may cause DM, other pathways might be involved. For example, after recovery from mild AP, there is an increased risk of new-onset DM years later, 6 suggesting ongoing metabolic changes after AP.…”

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confidence: 99%

Assessing the Pathophysiology of Hyperglycemia in the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study

et al. 2022

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ObjectivesThe metabolic abnormalities that lead to diabetes mellitus (DM) after an episode of acute pancreatitis (AP) have not been extensively studied. This article describes the objectives, hypotheses, and methods of mechanistic studies of glucose metabolism that comprise secondary outcomes of the DREAM (Diabetes RElated to Acute pancreatitis and its Mechanisms) Study.MethodsThree months after an index episode of AP, participants without preexisting DM will undergo baseline testing with an oral glucose tolerance test. Participants will be followed longitudinally in three subcohorts with distinct metabolic tests. In the first and largest subcohort, oral glucose tolerance tests will be repeated 12 months after AP and annually to assess changes in β-cell function, insulin secretion, and insulin sensitivity. In the second, mixed meal tolerance tests will be performed at 3 and 12 months, then annually, and following incident DM to assess incretin and pancreatic polypeptide responses. In the third, frequently sampled intravenous glucose tolerance tests will be performed at 3 months and 12 months to assess the first-phase insulin response and more precisely measure β-cell function and insulin sensitivity.ConclusionsThe DREAM study will comprehensively assess the metabolic and endocrine changes that precede and lead to the development of DM after AP.

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“…The latest stage in the semantic evolution of the notion was the introduction of 'diabetes of the exocrine pancreas', memorably and distinctly acronymised to DEP, in 2017 (31). The term has been increasingly used since then (1,32,33,34,35). Accumulating evidence shows that excessive intra-pancreatic fat deposition (located externally to the islets of Langerhans) plays a key role in the pathogenesis of diabetes secondary to pancreatitis, pancreatic cancer, and cystic fibrosis, but not in the pathogenesis of type 1 diabetes or type 2 diabetes (36,37,38,39,40,41).…”

Section: Semantic Evolutionmentioning

confidence: 99%

“…However, in a research setting, the use of oral glucose tolerance test may, in theory, enable an earlier diagnosing of PPDM as the test neither is confounded by the acute stress response (as is the case with fasting plasma glucose) nor requires the 90-day lag period (as is the case with glycated haemoglobin). A 2020 casecontrol study of 52 people from Ireland suggested that oral glucose tolerance test may be beneficial in diagnosing PPDM-A, though its findings are inconclusive because of the rather liberal inclusion criteria for diabetes and overly restrictive criteria for pancreatitis (33). Oral glucose tolerance test is also currently considered to be a more suitable diagnostic test for CFRD as earlier studies questioned the validity of glycated haemoglobin in this setting (15, 58).…”

Section: Core Entitiesmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Diagnosing and classifying diabetes in diseases of the exocrine pancreas

Petrov

Basina

2021

European Journal of Endocrinology

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Diabetes in the setting of diseases of the exocrine pancreas has long existed as a known, but underdiagnosed or misdiagnosed, disorder. It currently finds itself in a state of taxonomic dereliction and requires a long overdue refurbishment. Correct conceptualisation is a key precondition for knowledge development in this disorder. This article lays out the epistemiological foundation for diabetes of the exocrine pancreas (DEP) and presents a synthesis of the current interdisciplinary discourse on diagnosing and classifying DEP. The diagnosis of DEP is generally based on the most up-to-date biochemical criteria endorsed by the American Diabetes Association and European Association for the Study of Diabetes. The presence of exocrine pancreatic dysfunction is not considered a mandatory diagnostic criterion for DEP but is rather a significant risk factor for developing DEP. DEP principally comprises post-pancreatitis diabetes mellitus, pancreatic cancer-related diabetes, and cystic fibrosis-related diabetes, which are mutually exclusive with autoimmune diabetes and type 2 diabetes. Other exclusions and stipulations apply. The DEP criteria will be instrumental in aiding optimal design and conduct of clinical studies, uniform collection of health utilisation data, meaningful comparison of scientific findings across countries, and clear communication among stakeholders (healthcare providers, patients, health regulatory authorities, pharmaceutical industry).

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Metabolic dysfunction and diabetes mellitus during long-term follow-up of severe acute pancreatitis: A case-matched study

Cited by 12 publications

References 33 publications

Management of Acute Pancreatitis: Conservative Treatment and Step-Up Invasive Approaches—Evidence-Based Guidance for Clinicians

Management of Acute Pancreatitis: Conservative Treatment and Step-Up Invasive Approaches—Evidence-Based Guidance for Clinicians

Assessing the Pathophysiology of Hyperglycemia in the Diabetes RElated to Acute Pancreatitis and Its Mechanisms Study

DIAGNOSIS OF ENDOCRINE DISEASE: Diagnosing and classifying diabetes in diseases of the exocrine pancreas

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