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, PancreasFest Recommendation Conference Participants, Stephen Amann, John Baillie, Inna Belfer, Angela Criscimanna, Christopher DiMaio, Cheryl Gariepy, Andres Gelrud, Vay Liang Go, Abhinav Humar, Kyung Mo Kim, Louis Lambiase, Markus M Lerch, John Lieb, Mark Lowe, A James Moser, Rawad Mounzer, Thiruvengadam Muniraj, Walter Park, Mordechai Rabinovitz, Sara Schwarzenberg, Seth Sclair, Jose Serrano, Shailender Singh, C Mel Wilcox, John Windsor, Dhiraj Yadav, Venkata Akshintala, Kathryn Albers, Samer Alhabhan, K Louise Berry, Geoffrey Block, Lisa Bocelli DO, Sharon Boggiano, Brian Boone, Shailendra Chauhan, Jennifer Chennat, Sung Cho, Anthony Colatrella, Marie Cook, Emmanuel Coronel, Gregory Coté, Siddhartha Das, Brian Davis, Danielle Dwyer, Jeffrey Easler, John Eisses, Devrim Eren, Farzad Esni, Christopher Forsmark, Martin Freeman, Steven Friedman, Roberto Gamarra, Timothy Gardner, Lisa Glass, April Goddard, Tanja Gonska, Julia Greer, Nalani Guda, Celia Hartigan, Douglas Hartman, Michael Hollingsworth, Wang Hongjun, Sandra Hubatch, Sohail Husain, Jennifer Jacob, Karen Jerome-Zapadka, Kathleen Kerr, Alyssa Krasinskas, Soma Kumar, Alexander Larson, Jessica LaRusch, Peter Lee, Kenneth Lee, Tom Lin, Veronique Morinville, Daniel Mullady, Nagaraj Nagathihalli, Haq Nawaz, Stephen O'Keefe, Seak Hee, Joseph Palermo, Georgios Papachristou, Anoop Prabhu, Edward Purich, Andrew Rhim, Emily Rolfsmeyer, Cynthia Rudert, Bimaljit Sandhu, Wednesday Sevilla, Vijay P Singh, Adam Slivka, Sheila Solomon MS, Ashok Srinivasan, Rachelle Stopczynski, David Tuveson, Aliye Uc, Chandra Umapathy, Wahid Wassef, Yu Wen, Alnabhan Samer, Hongjun Wang, 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, PancreasFest Recommendation Conference Participants, Stephen Amann, John Baillie, Inna Belfer, Angela Criscimanna, Christopher DiMaio, Cheryl Gariepy, Andres Gelrud, Vay Liang Go, Abhinav Humar, Kyung Mo Kim, Louis Lambiase, Markus M Lerch, John Lieb, Mark Lowe, A James Moser, Rawad Mounzer, Thiruvengadam Muniraj, Walter Park, Mordechai Rabinovitz, Sara Schwarzenberg, Seth Sclair, Jose Serrano, Shailender Singh, C Mel Wilcox, John Windsor, Dhiraj Yadav, Venkata Akshintala, Kathryn Albers, Samer Alhabhan, K Louise Berry, Geoffrey Block, Lisa Bocelli DO, Sharon Boggiano, Brian Boone, Shailendra Chauhan, Jennifer Chennat, Sung Cho, Anthony Colatrella, Marie Cook, Emmanuel Coronel, Gregory Coté, Siddhartha Das, Brian Davis, Danielle Dwyer, Jeffrey Easler, John Eisses, Devrim Eren, Farzad Esni, Christopher Forsmark, Martin Freeman, Steven Friedman, Roberto Gamarra, Timothy Gardner, Lisa Glass, April Goddard, Tanja Gonska, Julia Greer, Nalani Guda, Celia Hartigan, Douglas Hartman, Michael Hollingsworth, Wang Hongjun, Sandra Hubatch, Sohail Husain, Jennifer Jacob, Karen Jerome-Zapadka, Kathleen Kerr, Alyssa Krasinskas, Soma Kumar, Alexander Larson, Jessica LaRusch, Peter Lee, Kenneth Lee, Tom Lin, Veronique Morinville, Daniel Mullady, Nagaraj Nagathihalli, Haq Nawaz, Stephen O'Keefe, Seak Hee, Joseph Palermo, Georgios Papachristou, Anoop Prabhu, Edward Purich, Andrew Rhim, Emily Rolfsmeyer, Cynthia Rudert, Bimaljit Sandhu, Wednesday Sevilla, Vijay P Singh, Adam Slivka, Sheila Solomon MS, Ashok Srinivasan, Rachelle Stopczynski, David Tuveson, Aliye Uc, Chandra Umapathy, Wahid Wassef, Yu Wen, Alnabhan Samer, Hongjun Wang
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.
Conflict of interest statement
Disclosure Statement: The authors have no relevant conflicts of interest related to this material.
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Source: PubMed