Determinants of glucose control in patients with chronic pancreatitis

• Published in: Diabetologia 2010-06, Vol.53 (6), p.1062-1069
• Main Authors: Schrader, H., Menge, B. A., Zeidler, C., Ritter, P. R., Tannapfel, A., Uhl, W., Schmidt, W. E., Meier, J. J.
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Biological and medical sciences; Blood Glucose - metabolism; Diabetes; Diabetes Mellitus - etiology; Diabetes Mellitus - metabolism; Diabetes Mellitus - pathology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Enzymes; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Glucose; Hospitals; Human Physiology; Humans; Hyperglycemia; Hyperglycemia - etiology; Hyperglycemia - metabolism; Hyperglycemia - pathology; Insulin; Insulin-Secreting Cells - metabolism; Insulin-Secreting Cells - pathology; Internal Medicine; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Other diseases. Semiology; Pancreas; Pancreatectomy; Pancreatitis; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - metabolism; Pancreatitis, Chronic - pathology; Pancreatitis, Chronic - surgery; Patients; Regression Analysis; Surgery
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-010-1705-0

Aims/hypothesis Diabetes frequently develops in patients with chronic pancreatitis (CP). Partial pancreatectomy has emerged as a treatment option for such patients. We addressed whether the development of diabetes in CP patients is related to pancreatic beta cell area or clinical variables, and which factors predict the diabetes risk after partial pancreatectomy. Methods Fractional beta cell area was determined in pancreatic tissue samples obtained from 114 CP patients undergoing pancreatic surgery and related to measures of glucose control, as well as clinical and anthropometric data. Seventy-four patients without diabetes at the time of surgery were contacted again 2.5 ± 1.0 years after partial pancreatectomy in order to obtain information about the post-operative development of diabetes. Results In the surgical samples in the whole cohort, pancreatic beta cell area was 0.40 ± 0.06% in patients with and 0.64 ± 0.06% in those without previously known diabetes ( p  = 0.039). There was an inverse non-linear relationship between pancreatic beta cell area and fasting glucose concentrations ( r  = 0.29) as well as HbA 1c levels ( r  = 0.36). Nineteen out of 74 previously normoglycaemic patients (26%) developed diabetes over an average period of 2.5 years of follow-up. Pre-operative fasting glucose levels, HbA 1c and BMI were identified as predictors of diabetes after partial pancreatectomy. However, pancreatic beta cell area did not differ in those who subsequently developed diabetes (0.66 ± 0.15%) and those who did not (0.62 ± 0.08%, p  = 0.45). Conclusions/interpretation Hyperglycaemia in CP patients is associated with reduced beta cell area. However, reduced beta cell area does not predict the development of diabetes, suggesting that other factors are more important determinants of alterations in glucose metabolism in patients with CP.