Early Alterations in Glycemic Control and Pancreatic Endocrine Function in Nondiabetic Patients With Chronic Pancreatitis. Issue 4 (April 2016)

• Record Type: Journal Article
• Authors: Lundberg, Rachel; Beilman, Gregory J.; Dunn, Ty B.; Pruett, Tim L.; Freeman, Martin L.; Ptacek, Peggy E.; Berry, Katherine Louise; Robertson, R. Paul; Moran, Antoinette; Bellin, Melena D.
• Is Part Of: Pancreas. Volume 45:Issue 4(2016)
• Publication Date: 2016-04
• Subjects: β cell -- pancreatitis -- diabetes -- total pancreatectomy and islet autotransplantation -- pancreatectomy -- islet; Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000000491
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : Objectives: Diabetes mellitus is a frequent consequence of chronic pancreatitis (CP). Little is known about pancreatic endocrine function before the development of diabetes mellitus in CP, particularly in females, or those without calcific and/or alcoholic pancreatitis. Methods: Twenty-five nondiabetic adult patients with CP (19 female; mean [SE] age, 34.2 [2.4] years) were compared with 25 healthy controls matched for age, sex, and body mass index. Subjects underwent frequent sample intravenous glucose tolerance testing (FSIVGTT) and mixed meal tolerance testing (MMTT). Results: Mean (SE) fasting glucose was higher in patients with CP (89.5 [2.3] mg/dL) than in controls (84.4 [1.2] mg/dL, P = 0.04). On MMTT, patients with CP had a higher area under the curve (AUC) glucose and AUC glucagon compared with controls ( P ⩽ 0.01). The AUC C-peptide was equivalent ( P = 0.6) but stimulated C-peptide at 30 minutes was lower in patients with CP ( P = 0.04). Mean insulin sensitivity index calculated from the FSIVGTT was lower in CP group, indicating reduced insulin sensitivity ( P ⩽ 0.01). Disposition index (insulin secretion adjusted for insulin sensitivity on FSIVGTT) was lower in patients with CP ( P = 0.01). Conclusions: Patients with CP had higher fasting and MMTT glucose levels, without a compensatory increase in insulin secretion suggesting subtle early islet dysfunction. Our cohort had relative hyperglucagonemia and was less insulin sensitive than controls. Abstract : Supplemental digital content is available in the text.