Summary.Clinical and Nochemical studies were carried out in 33 patients with diabetes secondary to chronic calcific, nonalcoholic pancreatitis (tropical pancreatic diabetes) and in 35 Type 2 (non-insulin-dependent) diabetic patients and 35 nondiabetic subjects. Despite lower body mass indices, only 250./0 of patients with tropical pancreatic diabetes had clinical evidence of malnutrition. There was no history of cassava ingestion. Mean serum cholesterol concentration was significantly lower in the tropical pancreatic diabetic patients (p < 0.01) in comparison with the Type 2 diabetic patients or non-diabetic subjects, due to a significantly decreased concentration of LDL cholesterol (p < 0.01) and VLDL cholesterol (p < 0.05). Basal and post-glucose stimulated concentrations of serum Cpeptide were highest in those pancreatic diabetic patients (n = 11) who responded to oral hypoglycaemic drugs, intermediate in the majority (n = i7), who were insulin dependent and ketosis resistant and negligible in a small sub-group (n = 5) who were ketosis prone. The occurrence of microangiopathy in pancreatic diabetic patients was common and similar to that in Type 2 diabetic patients. Thus, tropical pancreatic diabetes in South India appears to be heterogenous with respect to level of nutrition, severity of glucose intolerance, B-cell function, response to therapy and the occurrence of microvascular complications.Key words: Tropical pancreatic diabetes, heterogeneity, keto= sis-resistant, C-peptide, microangiopathy.While classical Type I (insulin-dependent) diabetes and Type 2 (non-insulin-dependent) diabetes are two well characterized entities of the diabetic syndrome, there are certain types of diabetes which do not fit into either of these categories. In tropical countries, diabetes associated with malnutrition, such as J-type diabetes [1,2] and tropical pancreatic diabetes [3-6[, have been described. Earlier studies have suggested the following characteristics of tropical pancreatic diabetes [5,6]: (1) Patients belong to the lowest socio-economic strata of society and appear grossly emaciated with signs of severe protein-calorie malnutrition. (2) They have severe insulin-dependent diabetes and often require large doses of insulin for stabilization of the diabetes. However, they are resistant to ketosis on withdrawal of insulin even for several weeks. (3) A history of cassava ingestion is very common.Recently, an explanation for the ketosis-resistant nature of tropical pancreatic diabetes has been put forward [7]. The present study demonstrates an interesting clinical and biochemical spectrum of tropical pancreatic diabetes as seen in the state of Tamitnadu (Madras) in South India.
Subjects and methodsSubjects studied were attending the M.V.Hospita[ for Diabetes, Madras, a large referral centre for diabetes in South India.The tollowing criteria were used for diagnosis of tropical pancreatic diabetes : (1) a history of recurrent abdominal pain fi'om an early age; (2) the presence of pancreatic calculi seen on plain abdominal ...
Insulin binding to erythrocyte insulin receptors was studied in 17 patients (13 men and 4 women) with fibrocalculous pancreatic diabetes mellitus (FCPD) and compared with that of 14 newly diagnosed NIDDM patients matched for age, sex and severity of hyperglycemia, and 14 age and sex-matched non-diabetic control subjects. In the uncompensated diabetic state, mean (+/- S.D.) specific binding of insulin was lower in both FCPD and NIDDM patients, compared with non-diabetic controls (P less than 0.001). Control of diabetes with short term therapy (2-6 weeks) resulted in a significant improvement in the mean specific insulin binding in both FCPD and NIDDM patients (P less than 0.001) due to increased binding affinity in the former, and increased affinity and the number of binding sites in the latter. As compared to short term therapy, chronic therapy (5-8 months) in FCPD patients resulted in a marginal decrease in specific insulin binding. However, this was still significantly higher than the basal value (P less than 0.05). FCPD patients had an initial low mean basal plasma IRI and a much lower mean stimulated IRI response as compared to NIDDM and non-diabetic controls.
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