Association between Pancreatic Atrophy and Loss of Insulin Secretory Capacity in Patients with Type 2 Diabetes Mellitus

Lü, Jun; Guo, Mengye; Wang, Hongtao; Pan, Hai-Bin; Wang, Liang; Yu, Xiang; Zhang, Xueli

doi:10.1155/2019/6371231

Cited by 11 publications

(3 citation statements)

References 25 publications

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“…with that in non-diabetic control individuals [7,8], supporting a bi-directional interaction between the endocrine and exocrine pancreas; however, discussion of this is beyond the scope of this article. Here we review several forms of pancreatogenic diabetes, highlighting the importance of the exocrine pancreas for the maintenance of pancreatic islet beta cell function and mass.…”

Section: Overviewmentioning

confidence: 84%

A tale of two pancreases: exocrine pathology and endocrine dysfunction

2020

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The islets of Langerhans are well embedded within the exocrine pancreas (the latter comprised of ducts and acini), but the nature of interactions between these pancreatic compartments and their role in determining normal islet function and survival are poorly understood. However, these interactions appear to be critical, as when pancreatic exocrine disease occurs, islet function and insulin secretion frequently decline to the point that diabetes ensues, termed pancreatogenic diabetes. The most common forms of pancreatogenic diabetes involve sustained exocrine disease leading to ductal obstruction, acinar inflammation, and fibro-fatty replacement of the exocrine pancreas that predates the development of dysfunction of the endocrine pancreas, as seen in chronic pancreatitis-associated diabetes and cystic fibrosis-related diabetes and, more rarely, MODY type 8. Intriguingly, a form of tumour-induced diabetes has been described that is associated with pancreatic ductal adenocarcinoma. Here, we review the similarities and differences among these forms of pancreatogenic diabetes, with the goal of highlighting the importance of exocrine/ductal homeostasis for the maintenance of pancreatic islet function and survival and to highlight the need for a better understanding of the mechanisms underlying these diverse conditions.

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Section: Overviewmentioning

confidence: 84%

A tale of two pancreases: exocrine pathology and endocrine dysfunction

2020

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“…The differential diagnosis for pancreatic atrophy includes chronic pancreatitis, autoimmune pancreatitis, pancreatectomy, immune checkpoint inhibitor therapy, type 2 diabetes mellitus, and pancreatic GVHD [4][5][6][7][8]. Chronic GVHD presenting with pancreatic atrophy is rare, and its natural history and pathophysiology are poorly defined.…”

Section: Discussionmentioning

confidence: 99%

Exocrine Pancreatic Insufficiency Possibly Related to Atypical Chronic Graft-versus-Host Disease

Hosokawa,

Toubai,

Ohya

et al. 2023

Case Rep Oncol

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We report the case of a 66-year-old woman who presented with diarrhea and weight loss approximately 14 months after unrelated allogeneic bone marrow transplantation for acute myeloid leukemia. Her early post-transplant course was notable for mild acute skin graft-versus-host disease (GVHD) and biopsy-proven upper gastrointestinal (GI) acute GVHD, both of which resolved with treatment. She then developed weight loss and diarrhea treated with prednisolone for what was thought to be GI late acute GVHD. However, her diarrhea and weight loss persisted. Colonoscopy showed a grossly intact mucosa, and stool studies only confirmed steatorrhea. However, an atrophic pancreas was found on an abdominal computed tomography (CT) scan. Exocrine pancreatic enzymes, such as lipase and pancreatic amylase, were markedly decreased, yet pancreatic endocrine function remained intact. The patient’s diarrhea and weight loss improved upon treatment with pancrelipase. Therefore, we suggest that her exocrine pancreatic insufficiency was likely partly caused by atypical chronic GVHD.

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“…While an absolute insulin deficiency characterizes T1DM, the natural history of T2DM is marked by IR in peripheral tissues. Yet, T2DM can also lead to insulin deficiency when insulin production is depleted due to exhaustion of pancreatic synthesis [ 14 , 108 ]. As in T2DM, the state of hyperinsulinemia found in T1DM affects glucose and lipid liver metabolism and triggers pro-inflammatory cascades that produce liver fibrosis and cirrhosis [ 3 , 29 , 109 , 110 ].…”

Section: Diabetes Clinical Phenotypesmentioning

confidence: 99%

When Sugar Reaches the Liver: Phenotypes of Patients with Diabetes and NAFLD

Rojano-Toimil

Rivera‐Esteban

Manzano-Núñez

et al. 2022

JCM

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Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been traditionally linked to one another. Recent studies suggest that NAFLD may be increasingly common in other types of diabetes such as type 1 diabetes (T1DM) and less frequently ketone-prone and Maturity-onset Diabetes of the Young (MODY) diabetes. In this review, we address the relationship between hyperglycemia and insulin resistance and the onset and progression of NAFLD. In addition, despite the high rate of patients with T2DM and other diabetes phenotypes that can alter liver metabolism and consequently develop steatosis, fibrosis, and cirrhosis, NALFD screening is not still implemented in the daily care routine. Incorporating a clinical algorithm created around a simple, non-invasive, cost-effective model would identify high-risk patients. The principle behind managing these patients is to improve insulin resistance and hyperglycemia states with lifestyle changes, weight loss, and new drug therapies.

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Association between Pancreatic Atrophy and Loss of Insulin Secretory Capacity in Patients with Type 2 Diabetes Mellitus

Cited by 11 publications

References 25 publications

A tale of two pancreases: exocrine pathology and endocrine dysfunction

A tale of two pancreases: exocrine pathology and endocrine dysfunction

Exocrine Pancreatic Insufficiency Possibly Related to Atypical Chronic Graft-versus-Host Disease

When Sugar Reaches the Liver: Phenotypes of Patients with Diabetes and NAFLD

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