Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: Recommendations from PancreasFest 2012

Michael R. Rickels, Melena Bellin, Frederico G.S. Toledo, R. Paul Robertson, Dana K. Andersen, Suresh T. Chari, Randall Brand, Luca Frulloni, Michelle A. Anderson, David C. Whitcomb

Research output: Contribution to journalArticlepeer-review

119 Scopus citations

Abstract

Description: Diabetes and glucose intolerance are common complications of chronic pancreatitis, yet clinical guidance on their detection, classification, and management is lacking. Methods: A working group reviewed the medical problems, diagnostic methods, and treatment options for chronic pancreatitis-associated diabetes for a consensus meeting at PancreasFest 2012. Results: Guidance Statement 1.1: Diabetes mellitus is common in chronic pancreatitis.While any patient with chronic pancreatitis should be monitored for development of diabetes, those with long-standing duration of disease, prior partial pancreatectomy, and early onset of calcific disease may be at higher risk. Those patients developing diabetes mellitus are likely to have co-existing pancreatic exocrine insufficiency. Guidance Statement 1.2: Diabetes occurring secondary to chronic pancreatitis should be recognized as pancreatogenic diabetes (type 3c diabetes). Guidance Statement 2.1: The initial evaluation should include fasting glucose and HbA1c. These tests should be repeated annually. Impairment in either fasting glucose or HbA1c requires further evaluation. Guidance Statement 2.2: Impairment in either fasting glucose or HbA1c should be further evaluated by a standard 75 g oral glucose tolerance test. Guidance Statement 2.3: An absent pancreatic polypeptide response to mixed-nutrient ingestion is a specific indicator of type 3c diabetes. Guidance Statement 2.4: Assessment of pancreatic endocrine reserve, and importantly that of functional beta-cell mass, should be performed as part of the evaluation and follow-up for total pancreatectomy with islet autotransplantation (TPIAT). Guidance Statement 3: Patients with pancreatic diabetes shall be treated with specifically tailored medical nutrition and pharmacologic therapies. Conclusions: Physicians should evaluate and treat glucose intolerance in patients with pancreatitis.

Original languageEnglish (US)
Pages (from-to)336-342
Number of pages7
JournalPancreatology
Volume13
Issue number4
DOIs
StatePublished - 2013

Bibliographical note

Funding Information:
This work was supported in part by conference grants from the National Institute of Diabetes and Digestive and Kidney Diseases [ R13DK083216 (2009), R13DK088452 (2010), and R13DK09604 (2012)] and accredited physician education supported by Abbott Laboratories, Aptalis Pharma, Boston Scientific, Cook Medical, Lilly, and Olympus through the University of Pittsburgh office of Continuing Medical Education . The authors thank Ms. Michelle Kienholz, Ms. Joy Jenko Merusi, and Ms. Marianne Davis for their expert assistance with the editing of this manuscript.

Keywords

  • Chronic pancreatitis
  • Diabetes mellitus
  • GLP-1
  • Glucose tolerance test
  • Incretin
  • Insulin
  • Pancreatic polypeptide
  • Pancreatogenic diabetes

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