Short and Long-Term Outcomes of Diabetes Mellitus in Patients with Autoimmune Pancreatitis after Steroid Therapy

Abstract

Background/AimsAutoimmune pancreatitis (AIP) is frequently associated with diabetes mellitus (DM). This study evaluated the effect of steroid therapy on the course of DM in AIP.MethodsGlucose tolerance was examined in 69 patients with AIP. DM onset was classified as either a simultaneous onset with AIP or an exacerbation of pre-existing DM. Based on the changes in the HbA1c levels and insulin dose, the responses of DM to steroids were classified as improved, no change, or worsened.ResultsThirty (46%) patients were diagnosed as having DM (simultaneous onset, n=17; pre-existing, n=13). Three months after starting the steroid treatment, the DM improved in 13 (54%) of 24 DM patients. The DM improved in 55%, had no change in 36%, and worsened in 9% of the 11 simultaneous onset DM patients, and it improved in 54%, had no change in 31%, and worsened in 15% of the 13 pre-existing DM patients. At approximately 3 years after starting the steroid treatment, the DM improved in 10 (63%) of 16 patients. The pancreatic exocrine function improved in parallel with the changes in the DM in seven patients.ConclusionsBecause approximately 60% of DM associated with AIP is responsive to steroids in the short- and long-terms, marked DM associated with AIP appears to be an indication for steroid therapy.

Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis

“…The change of glucose tolerance was evaluated as previously described 18. A decrease in the required dose of insulin in patients treated with insulin, or a decrease of HbA1c by more than 0.5% in patients treated with diet therapy or oral antidiabetic agents was judged as an improvement in glucose tolerance.…”

Diabetes mellitus asociada a pancreatitis autoinmune: Caso clínico

“…Nuestro paciente presentó valores de 339 mg/ dl (valor compatible con PAI). El diagnóstico se apoya en los hallazgos en estudios por imágenes, fundamentalmente tomografía computada (TAC) o RM, en las que se aprecia un aumento difuso de la glándula, con un halo de hipoatenuación alrededor del órgano, produciendo imagen de "salchicha" [6][7][8] . La RM permite, además, la visualización del conducto pancreático principal y evalúa compresión del segmento intrapancreático del colédoco.…”

“…Puede empeorar en sujetos de mayor edad y con DM de mayor tiempo de evolución 15 . La terapia esteroidal inactiva las células inflamatorias y fibroblastos, modulando los mecanismos autoinmunes involucrados y, por consiguiente, mejora el control glicémico 8 .…”

Long-term outcomes of autoimmune pancreatitis

“…At the time of AIP diagnosis, exocrine and endocrine insufficiencies were observed in 66%-81% and 46%-67% of cases, respectively[20-22]. After long-term follow-up, 34%-82% and 39%-57% of AIP patients had pancreatic exocrine and endocrine dysfunctions, respectively (Table 1)[15,23,24].…”

“…Some research studies emphasize that steroid therapy should be performed to preserve insulin secretion at the early stage of AIP or to improve glucose intolerance[22,28]. However, some cases show new onset of diabetes mellitus as a side effect of steroid therapy.…”