Diabetes mellitus in tropical chronic pancreatitis is not just a secondary type of diabetes

Aims: In chronic calcific pancreatitis of the tropics, etiology and relationship to developing diabetes mellitus are unknown. Some consider these cases a straightforward secondary type of diabetes, while others suggest selective β-cell impairment. Testing pancreatic function, we investigated whether...

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Published in:Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2004-01, Vol.4 (5), p.461-467
Main Authors: Rossi, L., Parvin, S., Hassan, Z., Hildebrand, P., Keller, U., Ali, L., Beglinger, C., Azad Khan, A.K., Whitcomb, David C., Gyr, N.
Format: Article
Language:English
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Summary:Aims: In chronic calcific pancreatitis of the tropics, etiology and relationship to developing diabetes mellitus are unknown. Some consider these cases a straightforward secondary type of diabetes, while others suggest selective β-cell impairment. Testing pancreatic function, we investigated whether selective β-cell impairment triggers diabetes associated with tropical pancreatitis. Methods: At a Bangladeshi research institute, 8 chronic tropical pancreatitis and no diabetes mellitus subjects, 14 fibrocalculous pancreatic diabetics and 27 matched healthy controls underwent arginine (endocrine pancreatic function) and secretin (exocrine pancreatic function assessment) stimulation tests. Results: All patients with clinically-diagnosed, chronic pancreatitis demonstrated pronounced exocrine pancreatic dysfunction with β-cell functioning differing significantly between the two groups. Compared to controls, patients having tropical pancreatitis and no diabetes showed normal plasma C-peptide values at baseline and after arginine stimulation, while fibrocalculous pancreatic diabetics demonstrated a typical diabetic pattern for plasma C-peptide levels. In contrast, pancreatic α-cell functioning (glucagon response to arginine) was preserved in both pancreatitis groups. Conclusion: A preserved pancreatic α-cell function in diabetics with advanced chronic pancreatitis of the tropics supports the concept of two different pathogenic mechanisms, one eliciting chronic pancreatitis and the other selective pancreatic β-cell impairment and subsequent diabetes mellitus.
ISSN:1424-3903
1424-3911
DOI:10.1159/000079849