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.
Bibliographical noteFunding 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: email@example.com). 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
- mixed meal