Metabolic dysfunction and diabetes mellitus during long-term follow-up of severe acute pancreatitis: a case-matched study

Sinead N. Duggan*, Donal B. O’Connor, Andrius Antanaitis, John R. Campion, Oladapo Lawal, Mohamed Ahmed, Ana Rakovac Tisdall, Mark Sherlock, Gerard Boran, Carel le Roux, James Gibney, Kevin C. Conlon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
9 Downloads (Pure)

Abstract

Background/objectives
Endocrine insufficiency following severe acute pancreatitis (SAP) leads to diabetes of the exocrine pancreas, (type 3c diabetes mellitus), however it is not known how this metabolic phenotype differs from that of type 2 diabetes, or how the two subtypes can be differentiated. We sought to determine the prevalence of diabetes following SAP, and to analyse the behaviour of glucose and pancreatic hormones across a 2-h oral glucose tolerance test (OGTT).

Methods
Twenty-six patients following SAP (mean (range) duration of first SAP episode to study time of 119.3 (14.8–208.9) months) along with 26 matched controls underwent an OGTT with measurement of glucose, insulin, c-peptide, glucagon and pancreatic polypeptide (PP) at fasting/15/90/120min. Beta-cell area was estimated using the 15min c-peptide/glucose ratio, and insulin resistance (IR) using homeostasis model assessment (HOMA) and oral glucose insulin sensitivity (OGIS) models.

Results
The prevalence of diabetes/prediabetes was 54% following SAP (38.5% newly-diagnosed compared to 19.2% newly-diagnosed controls). Estimated beta-cell area and IR did not differ between groups. AUC c-peptide was lower in SAP versus controls. AUC insulin and AUC c-peptide were lower in SAP patients with diabetes versus controls with diabetes; between-group differences were observed at the 90 and 120 min time-points only. Half of new diabetes cases in SAP patients were only identified at the 120min timepoint.

Conclusions
Diabetes and pre-diabetes occur frequently following SAP and are difficult to distinguish from type 2 diabetes in controls but are characterised by reduced insulin and c-peptide at later stages of an OGTT. Consistent with this observation, most new post SAP diabetes cases were diagnosed by 2-h glucose levels only.

Original languageEnglish
Pages (from-to)813-821
JournalPancreatology
Volume20
Issue number5
DOIs
Publication statusPublished - 05 Aug 2020
Externally publishedYes

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