Risk Factors Associated with Progression Toward Endocrine Insufficiency in Chronic Pancreatitis

Barite W. Gutama; Yi Yang; Gregory J. Beilman; Martin L. Freeman; Varvara A. Kirchner; Timothy L. Pruett; Srinath Chinnakotla; Elissa M. Downs; Guru Trikudanathan; Sarah J. Schwarzenberg; James S. Hodges; Melena D. Bellin

doi:10.1097/MPA.0000000000001394

Risk Factors Associated with Progression Toward Endocrine Insufficiency in Chronic Pancreatitis

Barite W. Gutama, Yi Yang, Gregory J. Beilman, Martin L. Freeman, Varvara A. Kirchner, Timothy L. Pruett, Srinath Chinnakotla, Elissa M. Downs, Guru Trikudanathan, Sarah J. Schwarzenberg, James S. Hodges, Melena D. Bellin

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

OBJECTIVE: Little data exist describing the change over time in islet function and glycemic control in patients with chronic pancreatitis (CP).

METHODS: In 325 CP patients who underwent 2 mixed meal tolerance tests and/or glycated hemoglobin (HbA1c) levels, we estimated the rate of change in metabolic measures per 6 months and assessed the association between potential risk factors for diabetes and rate of change using multivariate regression models.

RESULTS: Per 6-month time, HbA1c increased by 0.062% with a standard error of 0.029% (P = 0.037) and the ratio (area under the curve (AUC) C-peptide to AUC glucose from mixed meal tolerance testing) decreased by 0.0028 with a standard error of 0.0011 (P = 0.014). We observed more rapid decline in smokers (AUC C-peptide, P = 0.043) and patients with surgical drainage (AUC glucose, P = 0.001; ratio, P = 0.03) or with calcific pancreatitis (HbA1c, P = 0.003). In multivariate models, AUC C-peptide and ratio declined at a greater rate in smokers and HbA1c in those with pancreatic calcifications (both P < 0.05).

CONCLUSIONS: We observed a measurable decline in β-cell function and glycemic control in patients with CP. Patients with a history of tobacco smoking, surgical drainage, or pancreatic calcification may be at highest risk.

Original language	English (US)
Pages (from-to)	1160-1166
Number of pages	7
Journal	Pancreas
Volume	48
Issue number	9
DOIs	https://doi.org/10.1097/MPA.0000000000001394
State	Published - Oct 1 2019

Bibliographical note

Funding Information:
From the *Department of Surgery, University of Minnesota Medical School; †Division of Biostatistics, University of Minnesota; and Departments ‡Medicine, and §Pediatrics, University of Minnesota Medical School, Minneapolis, MN. Received for publication April 8, 2019; accepted August 13, 2019. Address correspondence to: Melena D. Bellin, MD, University of Minnesota Masonic Children's Hospital, E Bldg Rm MB-671, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: bell0130@umn.edu). M.B. receives research support from ViaCyte and Dexcom and has served on the medical advisory boards for ARIEL Precision Medicine and NovoNordisk. M.D.B., J.S.H., and Y.Y. are supported by NIH (R01 - DK109124). The other authors declare no conflict of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001394

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.

Keywords

diabetes
insulin
islet
mixed meal
pancreatitis

PubMed: MeSH publication types

Journal Article

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Risk Factors Associated with Progression Toward Endocrine Insufficiency in Chronic Pancreatitis",

abstract = "OBJECTIVE: Little data exist describing the change over time in islet function and glycemic control in patients with chronic pancreatitis (CP).METHODS: In 325 CP patients who underwent 2 mixed meal tolerance tests and/or glycated hemoglobin (HbA1c) levels, we estimated the rate of change in metabolic measures per 6 months and assessed the association between potential risk factors for diabetes and rate of change using multivariate regression models.RESULTS: Per 6-month time, HbA1c increased by 0.062% with a standard error of 0.029% (P = 0.037) and the ratio (area under the curve (AUC) C-peptide to AUC glucose from mixed meal tolerance testing) decreased by 0.0028 with a standard error of 0.0011 (P = 0.014). We observed more rapid decline in smokers (AUC C-peptide, P = 0.043) and patients with surgical drainage (AUC glucose, P = 0.001; ratio, P = 0.03) or with calcific pancreatitis (HbA1c, P = 0.003). In multivariate models, AUC C-peptide and ratio declined at a greater rate in smokers and HbA1c in those with pancreatic calcifications (both P < 0.05).CONCLUSIONS: We observed a measurable decline in β-cell function and glycemic control in patients with CP. Patients with a history of tobacco smoking, surgical drainage, or pancreatic calcification may be at highest risk.",

keywords = "diabetes, insulin, islet, mixed meal, pancreatitis",

author = "Gutama, {Barite W.} and Yi Yang and Beilman, {Gregory J.} and Freeman, {Martin L.} and Kirchner, {Varvara A.} and Pruett, {Timothy L.} and Srinath Chinnakotla and Downs, {Elissa M.} and Guru Trikudanathan and Schwarzenberg, {Sarah J.} and Hodges, {James S.} and Bellin, {Melena D.}",

note = "Funding Information: From the *Department of Surgery, University of Minnesota Medical School; †Division of Biostatistics, University of Minnesota; and Departments ‡Medicine, and §Pediatrics, University of Minnesota Medical School, Minneapolis, MN. Received for publication April 8, 2019; accepted August 13, 2019. Address correspondence to: Melena D. Bellin, MD, University of Minnesota Masonic Children's Hospital, E Bldg Rm MB-671, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: bell0130@umn.edu). M.B. receives research support from ViaCyte and Dexcom and has served on the medical advisory boards for ARIEL Precision Medicine and NovoNordisk. M.D.B., J.S.H., and Y.Y. are supported by NIH (R01 - DK109124). The other authors declare no conflict of interest. Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001394 Publisher Copyright: {\textcopyright} Wolters Kluwer Health, Inc. All rights reserved.",

year = "2019",

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doi = "10.1097/MPA.0000000000001394",

language = "English (US)",

volume = "48",

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T1 - Risk Factors Associated with Progression Toward Endocrine Insufficiency in Chronic Pancreatitis

AU - Gutama, Barite W.

AU - Yang, Yi

AU - Beilman, Gregory J.

AU - Freeman, Martin L.

AU - Kirchner, Varvara A.

AU - Pruett, Timothy L.

AU - Chinnakotla, Srinath

AU - Downs, Elissa M.

AU - Trikudanathan, Guru

AU - Schwarzenberg, Sarah J.

AU - Hodges, James S.

AU - Bellin, Melena D.

N1 - Funding Information: From the *Department of Surgery, University of Minnesota Medical School; †Division of Biostatistics, University of Minnesota; and Departments ‡Medicine, and §Pediatrics, University of Minnesota Medical School, Minneapolis, MN. Received for publication April 8, 2019; accepted August 13, 2019. Address correspondence to: Melena D. Bellin, MD, University of Minnesota Masonic Children's Hospital, E Bldg Rm MB-671, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: bell0130@umn.edu). M.B. receives research support from ViaCyte and Dexcom and has served on the medical advisory boards for ARIEL Precision Medicine and NovoNordisk. M.D.B., J.S.H., and Y.Y. are supported by NIH (R01 - DK109124). The other authors declare no conflict of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001394 Publisher Copyright: © Wolters Kluwer Health, Inc. All rights reserved.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - OBJECTIVE: Little data exist describing the change over time in islet function and glycemic control in patients with chronic pancreatitis (CP).METHODS: In 325 CP patients who underwent 2 mixed meal tolerance tests and/or glycated hemoglobin (HbA1c) levels, we estimated the rate of change in metabolic measures per 6 months and assessed the association between potential risk factors for diabetes and rate of change using multivariate regression models.RESULTS: Per 6-month time, HbA1c increased by 0.062% with a standard error of 0.029% (P = 0.037) and the ratio (area under the curve (AUC) C-peptide to AUC glucose from mixed meal tolerance testing) decreased by 0.0028 with a standard error of 0.0011 (P = 0.014). We observed more rapid decline in smokers (AUC C-peptide, P = 0.043) and patients with surgical drainage (AUC glucose, P = 0.001; ratio, P = 0.03) or with calcific pancreatitis (HbA1c, P = 0.003). In multivariate models, AUC C-peptide and ratio declined at a greater rate in smokers and HbA1c in those with pancreatic calcifications (both P < 0.05).CONCLUSIONS: We observed a measurable decline in β-cell function and glycemic control in patients with CP. Patients with a history of tobacco smoking, surgical drainage, or pancreatic calcification may be at highest risk.

AB - OBJECTIVE: Little data exist describing the change over time in islet function and glycemic control in patients with chronic pancreatitis (CP).METHODS: In 325 CP patients who underwent 2 mixed meal tolerance tests and/or glycated hemoglobin (HbA1c) levels, we estimated the rate of change in metabolic measures per 6 months and assessed the association between potential risk factors for diabetes and rate of change using multivariate regression models.RESULTS: Per 6-month time, HbA1c increased by 0.062% with a standard error of 0.029% (P = 0.037) and the ratio (area under the curve (AUC) C-peptide to AUC glucose from mixed meal tolerance testing) decreased by 0.0028 with a standard error of 0.0011 (P = 0.014). We observed more rapid decline in smokers (AUC C-peptide, P = 0.043) and patients with surgical drainage (AUC glucose, P = 0.001; ratio, P = 0.03) or with calcific pancreatitis (HbA1c, P = 0.003). In multivariate models, AUC C-peptide and ratio declined at a greater rate in smokers and HbA1c in those with pancreatic calcifications (both P < 0.05).CONCLUSIONS: We observed a measurable decline in β-cell function and glycemic control in patients with CP. Patients with a history of tobacco smoking, surgical drainage, or pancreatic calcification may be at highest risk.

KW - diabetes

KW - insulin

KW - islet

KW - mixed meal

KW - pancreatitis

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Risk Factors Associated with Progression Toward Endocrine Insufficiency in Chronic Pancreatitis

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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