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Pancreatogenic diabetes is a type of diabetes secondary to pancreatic exocrine disease, and it was officially named by American Diabetes Association in 2014. Chronic pancreatitis and pancreatic cancer are the most common causes of pancreatogenic diabetes. The pathogenesis of this disease remains unclear, and there is still a lack of systematic treatment regimens, which leads to the extremely high misdiagnosis rate of pancreatogenic diabetes in China and globally. In addition, studies have shown that compared with patients with type 2 diabetes, patients with pancreatogenic diabetes tend to have higher risks of death and readmission, which brings great challenges to the health and clinical treatment of patients. Therefore, the comprehensive understanding and early accurate identification and diagnosis of pancreatogenic diabetes are of great significance in reducing the disability and mortality rates of this disease. This article elaborates on the possible pathogenesis of pancreatogenic diabetes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Among different subtypes of pancreatogenic diabetes mellitus the biggest difficulties of glycemic control arise in patients after total duodenopancreatectomy (TDPE), first of all due to the presence of absolute insulin insufficiency.AIM: Estimating safety and cost-effectiveness Guardian Connect CGM system in early postoperative period in hospitalized patients after TDPE on continuous intravenous insulin therapy (CIVIT).MATERIALS AND METHODS: Glucose measurement results of 26 patients in early postoperative period after TDPE were analyzed. In 12 of them, we used Guardian Connect CGM system. In this group 43 cycles (1 cycle — 6 days, 258 days total) of CGM and 971 glucometer measurements used for CGM calibration were analyzed; in other 14 patients in whom only glucometer was used we analyzed 2496 glycemic values.Cost-effectiveness was calculated over 6 days for CGM and only glucometer use (including cost of CGM, glucometers, disposable materials, clinic wage-costs to medical staff for time required for glucose control).RESULTS: Glucose levels of group #1 were in the target range 5.6 to 10.0 mmol/L (66.7 vs 61.2%, p=0.003) and the range 4.3–11.6 mmol/L (85.2% vs 82.2%, p=0.038) more than in comparison with group #2.The frequency of hypoglycemic episodes (

Fixed-ratio combination injection therapy (FRC) is a fixed-ratio mixture containing basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA) in a single injection for the treatment of patients with type 2 diabetes. The two types of FRC products contain different concentrations and mixing ratios of basal insulin and GLP-1 RA. Both products demonstrated satisfactory blood glucose control throughout the day, with less hypoglycemia and weight gain. However, few studies have examined the differences in the actions of the two formulations. Herein, we present a case of a 71-year-old man with pancreatic diabetes and significantly impaired intrinsic insulin secretion capacity, who demonstrated a marked difference in glycemic control following treatment with two different FRC formulations. Treatment with IDegLira, an FRC product, demonstrated suboptimal glucose control in the patient. However, after a change in therapy to another FRC product, IGlarLixi, his glucose control markedly improved, even with a decrease in the injection dose. This difference could have been due to lixisenatide, a short-acting GLP-1RA contained in IGlarLixi, which exerts a postprandial hypoglycemic effect irrespective of intrinsic insulin secretion capacity. In conclusion, IGlarLixi has the potential to achieve good fasting and postprandial glucose control with a once-daily injection, even in patients with type 2 diabetes who have a reduced intrinsic insulin secretion capacity. [ABSTRACT FROM AUTHOR]

Abstract Background Emerging evidence demonstrates that surveillance of individuals at high-risk (HRIs) of developing pancreatic adenocarcinoma allows for identification and treatment of resectable tumors with improved survival. Population-based data suggest that hyperglycemia may be present up to three years before the development of pancreatic cancer. We investigated whether elevated hemoglobin A1c (HbA1c) is associated with the development of pancreatic cysts in a pancreatic surveillance program. Methods We performed a retrospective study of HRIs who underwent pancreatic surveillance at a single institution between May 2013 and March 2019, according to published criteria. We collected demographic information, clinical data including HbA1c, and imaging results. We compared data using univariable and multivariable analyses. Our primary outcome was the presence of pancreatic cysts on initial surveillance in patients with elevated HbA1c. Results Ninety-eight patients underwent surveillance imaging via EUS or MRCP and seventy-four patients met inclusion criteria. Thirty patients were found to have cysts on initial imaging. Older age (p 5.7% (aOR 5.82, 95% CI 1.50–22.54) remained associated with presence of cysts and solid lesions in HRIs. In patients with cysts or solid lesions there was a strong association between increased age and elevated HbA1c (p

Mycobacterium tuberculosis (TB) disease is a major global health problem affecting 10.6 million people worldwide, and India alone contributes 28% to this burden. Pancreatic TB is considered an extremely rare entity which closely mimics pancreatic carcinoma. However, while 87% of the total globally notified TB cases are from 30 high-burden countries mostly from Asia, about 45% of pancreatic TB cases are from developed countries. This suggests that the identified cases of pancreatic TB in developing counties are just the tip of iceberg, and many cases either remain undetected or wrongly diagnosed. The majority of the patients with pancreatic TB undergo extensive evaluation and frequently undergo major abdominal surgeries since pancreatic carcinoma is often considered as the most probable diagnosis before TB. Here, 2 cases of pancreatic TB managed separately at two different centers are described. Both cases presented with significant unintentional weight loss and poor glycemic control which is an unusual presentation for pancreatic TB. Imaging showed pancreatic mass lesions, and initially pancreatic carcinoma was considered by the treating physicians. Chromogranin A in both patients and tumor markers done in one of the patients were negative. Both the patients underwent Ga-68 DOTANOC PET/CT scan, and one of the patients even showed multiple DOTANOC avid lesions. Owing to contradictory biochemical and imaging findings, biopsy of the pancreatic mass was done which clinched the diagnosis of pancreatic TB. On starting standard anti-tubercular therapy (ATT), both patients showed clinical and radiological recovery with a significant regain of glycemic control. The clinical features, appropriate investigation including imaging and tissue biopsy, and treatment options are described in the article for better understanding of the disease. This may guide clinicians in early detection of pancreatic TB with least invasive diagnostic procedures., Competing Interests: The authors have no financial or other conflicts of interest to disclose., (© 2024 Varadaraj, Rai, Ghana, Maribashetti, Licensee HBKU Press.)

Introduction: Insulin-like growth factor 1 (IGF-1) has been connected with development of pancreatic ductal adenocarcinoma (PDAC). Aim: To evaluate the serum concentration levels of IGF-1 and insulin-like growth factor binding protein 2 (IGFBP-2) in patients with chronic pancreatitis (CP) and PDAC. Their values in diabetes mellitus (DM) were also assessed. Material and methods: The study included 83 patients with CP, 92 patients with PDAC, and 20 subjects as a control group. The concentrations of IGF-1 and IGFBP-2 were estimated with ELISA (Corgenix UK Ltd, R&D Systems). Results: The IGF-1 was higher in CP compared with PDAC (81.11 ±57.18 ng/ml vs. 53.18 ±36.05 ng/ml, p < 0.001), and both CP and PDAC were different from controls (81.11 ±57.18 ng/ml vs. 70.66 ±16.57 ng/ml, p < 0.001 and 53.18 ±36.05 ng/ml vs. 70.66 ±16.57 ng/ml, p < 0.001). CP without cysts have lower IGF-1 compared to those with CP and cysts (60.35 ±34.68 ng/ml vs. 93.55 ±64.78 ng/ml, p < 0.05). IGF-1 in CP without DM was higher compared to IGF-1 in PDAC without DM (91.13 ±65.48 ng/ml vs. 54.75 ±40.41 ng/ml, p < 0.001). In CP and DM the IGF-1 was elevated in comparison to PDAC and DM (62.20 ±32.38 ng/ml vs. 48.45 ±24.88 ng/ml, p < 0.05). IGFBP-2 was higher in CP compared to PDAC (512.42 ±299.77 ng/ml vs 301.59 ±190.36 ng/ml, p < 0.001). In CP and PDAC the IGFBP-2 level was elevated compared to the control group (512.42 ±299.77 ng/ml vs. 51.92 ±29.40 ng/ml, p < 0.001 and 301.59 ±190.36 ng/ml vs. 51.92 ±29.40 ng/ml, p < 0.001). IGFBP-2 in CP without DM was higher compared to PDAC without DM (559.39 ±281.43 vs. 296.53 ±196.93, p < 0.001). Conclusions: IGF-1 and IGFBP-2 may be biomarkers of CP and PDAC. IGF-1 may be an indicator that signals whether pancreatic diabetes is from CP or PDAC. [ABSTRACT FROM AUTHOR]

Introduction Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes<20 years of age in Germany. Methods Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20 251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1 269 631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Results Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P<0.001). In T2D, two-third of inpatient cases were not directly related to diabetes, and stay was shorter compared with T1D and T3D (3 vs. 4 and 5 days, respectively). In T1D, hospitalization was more frequent among girls than boys (0.58 vs. 0.49, P<0.001), and mostly due to "diabetes without complications" (65.7%). Hospitalization tended to be more frequent and longer in the youngest patients, and in those with east residence. Conclusion Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence demonstrates that surveillance of individuals at high-risk (HRIs) of developing pancreatic adenocarcinoma allows for identification and treatment of resectable tumors with improved survival. Population-based data suggest that hyperglycemia may be present up to three years before the development of pancreatic cancer. We investigated whether elevated hemoglobin A1c (HbA1c) is associated with the development of pancreatic cysts in a pancreatic surveillance program.Methods: We performed a retrospective study of HRIs who underwent pancreatic surveillance at a single institution between May 2013 and March 2019, according to published criteria. We collected demographic information, clinical data including HbA1c, and imaging results. We compared data using univariable and multivariable analyses. Our primary outcome was the presence of pancreatic cysts on initial surveillance in patients with elevated HbA1c.Results: Ninety-eight patients underwent surveillance imaging via EUS or MRCP and seventy-four patients met inclusion criteria. Thirty patients were found to have cysts on initial imaging. Older age (p < 0.01) and HbA1c in the prediabetic range or higher (p = 0.01) were associated with the presence of cysts or solid lesions on univariable analysis. After controlling for confounders, age (aOR 9.08, 95% CI 2.29-36.10), and HbA1c > 5.7% (aOR 5.82, 95% CI 1.50-22.54) remained associated with presence of cysts and solid lesions in HRIs. In patients with cysts or solid lesions there was a strong association between increased age and elevated HbA1c (p < 0.01).Conclusion: HRIs with elevated HbA1c were more likely to have pancreatic cysts compared to individuals with lower HbA1c on initial imaging in a pancreatic surveillance program. These findings may help tailor the surveillance protocols for those at increased risk of developing pancreatic adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: Only few studies have been conducted on pancreatic diabetes and data from large epidemiological studies are missing. Our main objective was to study the most important differences and similarities between pediatric individuals with pancreatic diabetes and type 1 diabetes (T1D). Methods: Patients <20 years of age were identified from the diabetes patient follow‐up registry (DPV). Data of the most recent treatment year between January 2000 and March 2018 were aggregated. Propensity score was used to match individuals with pancreatic diabetes to individuals with T1D. Matching was conducted one‐to‐one by sex, age, diabetes duration, body mass index SD score (BMI‐SDS), and migration background. Results: We studied 731 individuals with pancreatic diabetes and 74 460 with T1D. In the matched cohort of 631 pairs, HbA1c was significantly lower in pancreatic diabetes (7.4% [95% confidence interval: 7.2; 7.5%]) compared to T1D patients (8.7% [8.5; 8.8%]). Daily insulin dose (0.80 IU/kg [0.77; 0.84] vs 0.86 IU/kg [0.82; 0.90]) and insulin pump use (13.3% [10.7; 16.4] vs 22.1% [19.0; 25.6%]) were lower in patients with pancreatic diabetes. However, event rates of severe hypoglycemia were similar between pancreatic and T1D patients (8.8 [5.4; 14.2] vs 9.6 [5.9; 15.6] events per 100 patient years). Conclusions: With the use of robust epidemiological data, our study improves the knowledge on clinical characteristics in pediatric individuals with pancreatic diabetes. Moreover, our results serve as a basis to reconsider treatment options and for discussing clinical practice guidelines for patients with this rare medical condition. [ABSTRACT FROM AUTHOR]

The research of content of primary and secondary (lipohydroperoxides, malondialdehyde) products of free radical oxidation of lipids in blood serum, and. indices of activity of antioxidant enzymes (glutathione peroxidase and. glutathione reductase) in 62 patients with pancreatic diabetes of type II. In 28 patients of them, the disease was complicated by suppurative inflammation of the foot. On the basis of these data we proposed a method of forecasting of the development of infectious complications in these patients at the stage of pre-clinical manifestations. This allows to make necessary pharmacological correction in the treatment of patients with pancreatic diabetes promptly to prevent the development of diabetic foot syndrome.

The study of the psychological status of 224 type 1 and 2 pancreatic diabetes (PD) patients has revealed the dominant types of the attitude to illness. In type 1 PD patients, regardless of the sex, the dominant type was ergopatic, which may lead tounsatisfactory results of treatment. However, the anosognosiс type of attitude was observed reliably more often in men with type PD than in women. In type 2 PD patients, the harmonic type dominated. At the same time, the disturbing type was observed in women, but not diagnosed in men with type 2 PD.

Introduction The paucity of specific standardized criteria leads to uncertainties in clinical practice regarding the management of chronic pancreatitis (CP).Objectives This paper reports some of the systematic guidelines for the diagnosis and treatment of CP recently elaborated by an Italian multicenter study group. We review recommendations on clinical and nutritional aspects of the disease, assessment of pancreatic function, treatment of exocrine pancreatic failure and secondary diabetes, treatment of pain, and prevention of painful relapses. The review also looks at the role of endoscopy in the management of pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications; the appropriate use of various imaging techniques, including endoscopic ultrasound; and the indications for and techniques used in surgical management of CP.

Aim: To determine oxidant stress and antioxidant capacity in chronic pancreatitis (CP) patients with and without diabetes mellitus. Methods: This study is a secondary data analysis of our earlier study on 127 (male = 86) patients with CP, grouped as those with diabetes (case; n = 23) and those without diabetes (control). Markers of antioxidant status included vitamins A and E, total antioxidant capacity (TAC; measured as ferric-reducing ability of plasma [FRAP]), and total glutathione (T-GSH). Markers for oxidative stress included lipid peroxidation, measured as thiobarbituric acid reactive substances (TBARS) and serum superoxide dismutase (s-SOD). Results: Patients with diabetes were older (mean [SD] age 36.4 [9.7] vs. 29.3 [10.0] years; p = 0.032), had longer duration of CP [4 (0.3-21) vs. 3 (0.3-24) years; p = 0.07), and had a lower TAC (269.8 [92.4] vs. 355.5 [128.6] μmoles Fe liberated; p = 0.003) compared to those without diabetes. In multiple logistic regression analysis taking all exploratory variables, FRAP (<270 μmoles Fe liberated) was associated with diabetes independent of duration of CP, age of patients, and TBARS levels. However, oxidative stress levels were not different between diabetic and nondiabetic patients. Conclusions: Diabetes was found to be associated with longer duration of CP and with low antioxidant capacity. Further studies will be needed to evaluate a causal association. [ABSTRACT FROM AUTHOR]

Although patients with autoimmune pancreatitis (AIP) tend to have concurrent diverse disorders, very few studies have focused on diabetes mellitus (DM) coexisting with AIP. In total 102 AIP patients with DM were divided into three groups. Those with DM before the onset of AIP were labeled group A ( n = 35), those who developed DM and AIP simultaneously were labeled group B ( n = 58) and those who developed DM after steroid therapy for AIP were labeled group C ( n = 9). The characteristics of DM among the three groups were evaluated. No significant differences were noted in the age of DM onset among the three groups. However, the mean duration of DM was significantly longer in group A (8.7 years) than in groups B and C. AIP developed 6.8 years after DM onset in group A, whereas it developed 1.8 years after steroid therapy in group C. Group A had the highest rate (25.7%) of family members with a history of AIP. Levels of serum albumin, total cholesterol and triglyceride were significantly lower in group A. No correlations were found between glycated hemoglobin and benzoyl-tyrosyl para-aminobenzoic acid. Hypoglycemia was observed in 20% of patients under insulin therapy. Most of them were habitual drinkers and received no pancreatic enzymes. Group A showed a high prevalence of retinopathy, nephropathy and macrovascular disorders than group B. Aspects of AIP-associated pancreatic diabetes were clarified. AIP-associated DM must be controlled by a full assessment of the pancreatic endocrine and exocrine function. [ABSTRACT FROM AUTHOR]

[Abstract] Objective To study the incidence and clinical profile of pancreatic diabetes among the patients of insulin dependent diabetes mellitus. Methods 75 patients with diabetes with onset before 40 years of age were taken for the study. Diabetes is diagnosed by using criteria of American Diabetes Association. Pancreatic diabetes is diagnosed by using modified Bajaj Criteria. Results In pancreatic diabetes the male female ratio was 1. 2 : 1. Age group of the patients ranged from 12-40 years. Mean age ± SD at onset of symptoms was 16. 2 ± 2. 64 years. Jowar was the staple food in 96. 4% of cases. Mean age ± SD at onset of pain abdomen was 9 ± 1.4 years. The mean age ± S1) of interval between the onset of abdominal pain and onset of symptoms was 7.46 ± 2.02 years. Abdominal pain and steatorrhoea were present in 92. 8% and 35.7% of cases respectively. Plain X-ray abdomen showed pancreatic calculi in 50% cases. Ultrasonography of abdomen show's pancreatic calculi in all cases. Conclusion Pancreatic diabetes is common entity in diabetics who are less than 40 years old and constitutes 37. 3% of the total diabetics below 40 years of age. While the age of onset of symptoms was comparatively earlier in type I diabetes abdominal pain, parotid gland enlargement, blue lips and steatorrhoea were more common in pancreatic diabetes. FBS, PPBS and daily insul1in requirement are higher in pancreatic diabetes. [ABSTRACT FROM AUTHOR]

Pancreatic diabetes is secondary diabetes followed by progressions of pancreatic exocrine diseases, such as chronic pancreatitis, pancreatic neoplasm and post-pancreatectomy. Because of destruction and reduction of the pancreatic endocrine and exocrine functional compartments, patients with pancreatic diabetes frequently show malnutrition from maldigestion and malabsorption by insufficiencies in pancreatic digestive enzymes, and show unstable glycemic control and prolonged hypoglycemia by insufficiencies in synthesis and secretion of insulin and glucagon. Epidemiological studies have suggested that the incidence and development of pancreatic diabetes in patients with chronic pancreatitis (CP) depends on several risk factors, such as alcohol intake, the presence of pancreatic calcification and the long-term duration of CP. The clinical management of pancreatic diabetes is divided into two parts: one is the supplementation of pancreatic digestive enzymes and the other is the achievement of appropriate glycemic control. The appropriate and sufficient pancreatic exocrine replacement therapy is important for the maintenance of better nutrient conditions for patients with pancreatic diabetes. Furthermore, the intensive insulin therapy combined with short- or ultra-short-acting insulin and long-acting insulin glargine can be achieved for stable glycemic control and reduction of severe frequent hypoglycemia in patients with pancreatic diabetes. These current advanced management techniques against insufficiencies of pancreatic exocrine endocrine functions are beneficial for improving and maintaining the quality of life in patients with pancreatic diabetes. [ABSTRACT FROM AUTHOR]

We aimed to determine the cumulative rate of diabetes mellitus (DM) and the risk factors for DM in patients with chronic pancreatitis (CP) in Japan. We conducted a follow-up survey of CP in 2002 in patients registered as having CP in 1994, and confirmed 656 patients to be checked in regard to the survey items concerning diabetes. We analyzed the cumulative rate of DM and the risk factors for DM over an 8-year follow up period. In 1994, 35.1% of 656 CP patients had DM, and the incidence of diabetes had increased to 50.4% in 2002. Of 418 patients without diabetes in 1994, 28.9% (121/418) were newly diagnosed with DM in 2002. Alcoholic CP was the most common type of CP in patients with newly developed diabetes, accounting for 67.8%. The incidence of DM was highest in those with alcoholic CP (34.3%) followed by idiopathic CP (23.0%). The risk of diabetes increased 1.32-fold after the onset of pancreatic calcification. Of 121 patients with newly diagnosed DM in 2002, 37 (30.6%) had pancreatic stones in 1994 and 49 (40.5%) had a stone in 2002. The highest incidence of newly diagnosed DM was observed in patients with continuous alcoholic intake (40.9%). Patients treated with camostat mesilate developed DM less frequently than those without camostat mesilate. The present study showed that the incidence of DM in patients with CP increased with time. Of 418 CP patients without DM in 1994, 28.9% developed DM over a period of 8 years. Continuous alcoholic intake aggravated CP and increased the risk of DM in those with CP. [ABSTRACT FROM AUTHOR]

Background and Aims: Instillation of trinitrobenzene sulfonic acid (TNBS) into the rat pancreatic ducts induces morphological changes resembling human chronic pancreatitis. In humans, alcoholism is commonly associated with chronic pancreatitis, but ethanol feeding fails to induce pancreatitis in experimental animals. We hypothesized that ethanol would manifest its pathogenetic effects on a duct-injured pancreas. Methods: Chronic pancreatitis was induced in rats by instillation of TNBS into pancreatic ducts. Thereafter, rats were fed a normal chow diet with or without ethanol supplementation. Control rats received vehicle and a normal diet. A separate group of vehicle-treated rats were also fed with ethanol. At 2 and 4 weeks pancreata were excised and processed for morphological examination or for biochemical assays. From crude homogenates, protein and hydroxyproline were quantified. After sonication, homogenates were also assayed for amylase and DNA. An oral glucose tolerance test was performed on the fourth week. Results: TNBS induced chronic fibrogenic pancreatitis that was associated with a reduction in pancreatic weight, DNA, protein and amylase as compared to control rats. Ethanol feeding to TNBS-treated animals slowed weight gain, increased fasting glucose and impaired glucose tolerance test. Larger areas of gland atrophy were observed with a striking disruption of the normal architecture of the islets. Ethanol accelerated pancreatic involution and collagen deposition as measured by total amylase, protein, DNA and hydroxyproline content. Conclusions: In TNBS chronic pancreatitis, active fibrogenesis is associated with progressive atrophy of glandular elements. Morphological and biochemical parameters are aggravated by sustained ethanol intake. [ABSTRACT FROM AUTHOR]

Abstract In rare cases (1-8%) diabetic patients with end-stage renal disease (ESRD) suffer from diabetic nephropathy (dNP) due to pancreatic diabetes mellitus (PDM). Aim of this study was to investigate differences in the outcome of patients with PDM and those with type 2 diabetes. In a retrospective study we evaluated 96 diabetic patients, who started hemodialysis (HD) in our dialysis centre (1997-2005). In 12 patients PMD was diagnosed, and 84 patients had type 2 diabetes. In both groups we compared vascular risk factors and prevalence of vascular diseases at the start of dialysis. We also evaluated incidence of malnutrition, and 5-year survival in both patient groups. The vascular risk factors were similar in both patient groups, also the prevalence of vascular diseases at the initiation of HD was similar in both groups. In the patients with PDM the mean BMI (kg/m2) was lower (22 + 3 versus 25 + 3), and also their serum albumin was lower (2.7 + 0.3 versus 3.4 + 0.3 g/dl, p < 0.05). Four of these patients (33%) developed malnutrition (BMI < 18.5). In the patients with PDM the age adjusted 5-year survival was significantly lower (8% versus 27%, p < 0.05) than in the type 2 diabetic patients. Conclusions in HD-treated patients with type 2 diabetes or PDM the prevalence of vascular diseases was not significantly different. The lower survival of PDM patients can be related to poor nutrition status.

Conclusions. Marked diabetic micro- and macroangiopathies were recognized in three autopsy cases with pancreatic diabetes resulting from chronic pancreatitis. Background. Recent reports have suggested that diabetic retinopathy occurs as one of the microangiopathies in patients with secondary diabetes following chronic pancreatitis. Methods. We report three autopsy cases with pancreatic diabetes. Cases 1 and 2 showed alcoholic chronic pancreatitis. Case 3 was a patient with chronic pancreatitis resulting from hyperparathyroidism. All three cases had pancreatic calcification and markedly decreased exocrine pancreatic function. There was no family history of diabetes in these patients. The HbA1 values were elevated, with diminished secretion of both insulin and glucagon. Results. The common features of the clinical courses were poor glycemic control, including insulin-induced hypoglycemic attacks in the early stage and microangiopathy, followed by difficulties in treatment for hypertension in the late stage of pancreatic diabetes. Autopsies, performed after 12–18 yr of diabetes, revealed fibrosis of the pancreas, disappearance of acinar cells in the exocrine pancreas, atrophy, a diminished number of islets of Langerhans, and diabetic glomerulosclerosis, with arteriosclerosis in the brain, heart, and kidneys. Cerebral hemorrhage, heart failure, and myocardial infarction were suggested to be the main causes of death. Although the serum lipid levels were rather low in cases 1 and 2, arteriosclerosis was marked by the age of 60, and serum protein levels were also low in all three cases. [ABSTRACT FROM AUTHOR]

Conclusion: Pancreatic endocrine capacities are remarkably disturbed in patients with pancreatic diabetes owing to calcific pancreatitis as opposed to those owing to noncalcific pancreatitis. Insulin secretion in calcific pancreatitis resembled, that in insulin-dependent diabetes mellitus (IDDM), whereas insulin secretion in noncalcific pancreatitis resembled that in non-IDDM (NIDDM). The involvements of acinar cell and ductal cell function closely correlate with endocrine function (insulin and glucagon secretions) in chronic pancreatitis (pancreatic diabetes). Background: We sought to clarify the differences of pancreatic endocrine function between pancreatic diabetes and primary diabetes, and to verify the correlations between pancreatic exocrine and endocrine dysfunction in patients with chronic pancreatitis. Methods: Urinary C-peptide (CPR) excretion and fasting plasma glucagon levels in patients with pancreatic diabetes owing to calcific pancreatitis (19 cases) and owing to noncalcific pancreatitis (14 cases) were studied in comparison with those in patients with insulin-dependent diabetes mellitus (IDDM, 23 cases), noninsulin-dependent diabetes (NIDDM, 18 cases), and in healthy controls (11 cases). In addition, pancreatic exocrine function was investigated in patients with chronic pancreatitis (calcific and noncalcific) and in healthy controls. The correlation between pancreatic exocrine and endocrine function was studied. Results: The urinary CPR excetion in controls was 94.9±20.5 μg/d. The urinary CPR excretion in calcific pancreatitis was 12.8±7.4 μg/d and it resembled that in IDDM (9.4±5.8 μg/d). The urinary CPR excretion in noncalcific pancreatitis was 41.5±30.1 μg/d, being similar to that in NIDDM (49.3±21.0 μg/d). The plasma glucagon level in calcific pancreatitis was 64.1±15.9 ρg/mL, which was significantly lower than the values in IDDM (111.2±50.2 ρg/mL) and NIDDM (96.7±21.9 ρg/mL). The plasma glucagon level in calcific and noncalcific pancreratitis (88.4±29.6 ρg/mL) were significantly lower than that in controls (12.9±21.6 ρg/mL). The residual capacities of acinar cells and ductal cells were strongly correlated with urinary CPR excretion and plasma glucagon concentration. [ABSTRACT FROM AUTHOR]

Evidence is present that plasma contains non-specific factors which interfere with the 30K glucagon assays. A correction can be made for these interference factors because the factors can be quantitated following absorption of glucagon with charcoal-dextran. Using a correction factor the range of fasting plasma immunoreactive glucagon (IRG) in 12 totally pancreatectomized patients was below detectable limit. Fasting levels of IRG were determined on the plasma from 25 liver cirrhotics complicated by abnormal GTT, 13 pancreatic diabetics with chronic calcified pancreatitis (CCP), 25 adult-onset primary diabetics and 25 healthy subjects. When all samples were measured using no correction factor, the mean levels of IRG were 358 ± 24 (mean ± SE), 170 ± 26, 178 ± 16 and 178 ± 7 pg/ml, respectively. Using a correction factor the mean levels of IRG were 177 ± 26, 16 ± 4, 39 ± 9 and 20 ± 4 pg/ml, respectively. The mean values of the interference factor were not significantly different among all five groups. During an arginine infusion the interference factor remained unchanged despite an increase in IRG. It is available but not always necessary to apply a correction factor for 30K glucagon radioimmunoassay. [ABSTRACT FROM AUTHOR]