No acute pancreatitis but reduced exocrine pancreatic function at diagnosis of type 1 diabetes in children

Ludvigsson, Johnny

doi:10.1111/pedi.12904

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…Exocrine pancreas dysfunction is commonly accepted as a feature of type 1 diabetes, as evidence from multiple independent studies have shown decreased levels of pancreatic enzymes [15][16][17][18][27][28][29][30]. In this study, we demonstrate that impaired exocrine function, resulting in lower levels of circulating P-amylase and lipase, can be detected long before the onset of clinical symptoms in at-risk adult individuals, but not in children.…”

Section: Discussionsupporting

confidence: 47%

Exocrine pancreas function is impaired in adult relatives of patients with type 1 diabetes

et al. 2021

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Aims Alterations of the exocrine pancreas have been reported in type 1 diabetes, but their contribution to the pathogenesis of the disease is poorly understood. Here, we investigated markers of exocrine pancreas dysfunction in individuals at-risk of developing type 1 diabetes. Methods Serum P-amylase and lipase levels were assessed in samples obtained from healthy controls, patients with new onset type 1 diabetes, relatives participating to the TrialNet Pathway to Prevention who were, at blood collection, autoantibody negative or positive for a single autoantibody (low-risk individuals), and positive for multiple autoantibodies (high-risk individuals). Linear mixed models were adopted to estimate variation of pancreatic enzymes among the groups and to evaluate the influence of high-risk HLA genotypes and residual beta cell function on exocrine pancreas function. Results In adults, but not children, reduced levels of P-amylase and lipase were shown in at-risk individuals, including (for P-amylase levels only) those at low-risk, and in T1Dnew. Furthermore, while high-risk HLA genotypes negatively affected P-amylase levels in autoantibody negative adult individuals, fasting C-peptide levels did not correlate with pancreatic enzyme levels. Conclusions Exocrine pancreas dysfunction precedes the onset of type 1 diabetes in adult at-risk individuals and may be unrelated to fasting C-peptide levels.

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Section: Discussionsupporting

confidence: 47%

Exocrine pancreas function is impaired in adult relatives of patients with type 1 diabetes

et al. 2021

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“…Subclinical exocrine dysfunction was detected in T1D as early as 1943 (1), with numerous confirmations in all age groups (2)(3)(4)(5). The exocrine pancreas comprises greater than 95% of the pancreas volume and magnetic resonance imaging shows that the volume decreases stepwise from healthy controls, to first-degree relatives, to first-degree relatives with islet autoimmunity (IA), to individuals with recent-onset T1D and those with longer duration T1D (6,7).…”

Section: Introductionmentioning

confidence: 99%

Changes in pancreatic exocrine function in young at‐risk children followed to islet autoimmunity and type 1 diabetes in the ENDIA study

et al. 2020

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“…There could be several reasons for this. One is some children with ARP had T1DM and may have coexisting exocrine pancreatic disease as previously described (42,43). Another possibility is the diiculty in identifying EPI.…”

Section: Discussionmentioning

confidence: 94%

Analysis of INSPPIRE‐2 Cohort

Uç¹,

Cress²,

Wang³

et al. 2022

J. pediatr. gastroenterol. nutr.

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Objectives: The objective of this study is to investigate risk factors and disease burden in pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Methods: Data were obtained from INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2), the largest multi-center prospective cohort study in pediatric patients with ARP or CP. Results: Of 689 children, 365 had ARP (53%), 324 had CP (47%). CP was more commonly associated with female sex, younger age at first acute pancreatitis (AP) attack, Asian race, family history of CP, lower BMI%, genetic and obstructive factors, PRSS1 mutations and pancreas divisum. CFTR mutations, toxic-metabolic factors, medication use, hypertriglyceridemia, Crohn disease were more common in children with ARP. Constant or frequent abdominal pain, emergency room (ER) visits, hospitalizations, medical, endoscopic or surgical therapies were significantly more common in CP, episodic pain in ARP. A total of 33.1% of children with CP had exocrine pancreatic insufficiency (EPI), 8.7% had diabetes mellitus. Compared to boys, girls were more likely to report pain impacting socialization and school, medical therapies, cholecystectomy, but no increased opioid use. There was no difference in race, ethnicity, age at first AP episode, age at CP diagnosis, duration of disease, risk factors, prevalence of EPI or diabetes between boys and girls. Multivariate analysis revealed that family history of CP, constant pain, obstructive risk factors were predictors of CP. Conclusions: Children with family history of CP, constant pain, or obstructive risk factors should raise suspicion for CP.

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No acute pancreatitis but reduced exocrine pancreatic function at diagnosis of type 1 diabetes in children

Cited by 9 publications

References 23 publications

Exocrine pancreas function is impaired in adult relatives of patients with type 1 diabetes

Exocrine pancreas function is impaired in adult relatives of patients with type 1 diabetes

Changes in pancreatic exocrine function in young at‐risk children followed to islet autoimmunity and type 1 diabetes in the ENDIA study

Analysis of INSPPIRE‐2 Cohort

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