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

Pancreatology. Jul-Aug 2013;13(4):336-42. doi: 10.1016/j.pan.2013.05.002. Epub 2013 May 17.

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.

Keywords: Chronic pancreatitis; Diabetes mellitus; GLP-1; Glucose tolerance test; Incretin; Insulin; Pancreatic polypeptide; Pancreatogenic diabetes.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diabetes Mellitus / diagnosis*
  • Diabetes Mellitus / etiology*
  • Diabetes Mellitus / therapy
  • Glucose Intolerance / diagnosis
  • Glucose Intolerance / therapy
  • Glucose Tolerance Test
  • Humans
  • Islets of Langerhans Transplantation
  • Pancreas / physiopathology
  • Pancreatitis, Chronic / complications*
  • Transplantation, Autologous