Diabetes of the exocrine pancreas

Wynne, Katie; Devereaux, Benedict M.; Dornhorst, Anne

doi:10.1111/jgh.14451

Cited by 70 publications

(76 citation statements)

References 65 publications

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“…Treatment is based on first principles and is determined by the clinical presentation and laboratory parameters. For example, pancreatic exocrine insufficiency may present in up to 1.8% of patients newly diagnosed with diabetes; this tends to be a more brittle form of diabetes, requiring early insulin therapy [152]. Given the rapid fluctuation in glucose control, many patients with this condition may require MDI and should be treated in Ramadan as one would treat a person with T1 diabetes.…”

Section: Other Forms Of Diabetes Mellitusmentioning

confidence: 99%

Ramadan and Diabetes: A Narrative Review and Practice Update

et al. 2020

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Fasting in the Islamic month of Ramadan is obligatory for all sane, healthy adult Muslims. The length of the day varies significantly in temperate regions-typically lasting C 18 h during peak summer in the UK. The synodic nature of the Islamic calendar means that Ramadan migrates across all four seasons over an approximately 33-year cycle. Despite valid exemptions, there is an intense desire to fast during this month, even among those who are considered to be at high risk, including many individuals with diabetes mellitus. In this review we explore the current scientific and clinical evidence on fasting in patients with diabetes mellitus, focussing on type 2 diabetes mellitus and type 1 diabetes mellitus, with brief reviews on pregnancy, pancreatic diabetes, bariatric surgery, the elderly population and current practice guidelines. We also make recommendations on the management of diabetes patients during the month of Ramadan.

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Section: Other Forms Of Diabetes Mellitusmentioning

confidence: 99%

Ramadan and Diabetes: A Narrative Review and Practice Update

et al. 2020

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“…symptoms related to pancreatic disease, including decreased glucagon and somatostatin, pancreatic exocrine insufficiency (PEI), malabsorption of nutrients and micronutrients, severe and painful gastrointestinal symptoms, and nutritional deficiencies (Wynne et al, 2019). These additional morbidities promote greater blood glucose fluctuations.…”

mentioning

confidence: 99%

“…Identification of the disease emphasizes the detection of exocrine pancreatic disorders and pathological changes of the exocrine pancreas different than the autoimmune mechanism which is the characteristic of type 1 diabetes mellitus (T1DM). The current proposed diagnostic criteria include evidence of pancreatic exocrine disease such as functional insufficiency (identified with tests of the fecal elastase-1 or exocrine pancreatic function) and pathological changes of pancreatic imaging [computerized tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound], as well as potential alterations in incretin secretion and decreased levels of fat soluble vitamins (A, D, E, and K) in serum (Ewald and Bretzel, 2013;Wynne et al, 2019). In addition, certain novel biomarkers showed potential in discriminate DEP from other diabetes (Olesen et al, 2019;Bharmal et al, 2020b;Gold-Smith et al, 2020).…”

mentioning

confidence: 99%

Pathological Mechanisms in Diabetes of the Exocrine Pancreas: What’s Known and What’s to Know

Wei

Lin

et al. 2020

Front. Physiol.

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The clinical significance of diabetes arising in the setting of pancreatic disease (also known as diabetes of the exocrine pancreas, DEP) has drawn more attention in recent years. However, significant improvements still need to be made in the recognition, diagnosis and treatment of the disorder, and in the knowledge of the pathological mechanisms. The clinical course of DEP is different from type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). DEP develops in patients with previous existing exocrine pancreatic disorders which damage both exocrine and endocrine parts of pancreas, and lead to pancreas exocrine insufficiency (PEI) and malnutrition. Therefore, damage in various exocrine and endocrine cell types participating in glucose metabolism regulation likely contribute to the development of DEP. Due to the limited amount of clinical and experimental studies, the pathological mechanism of DEP is poorly defined. In fact, it still not entirely clear whether DEP represents a distinct pathologic entity or is a form of T2DM arising when β cell failure is accelerated by pancreatic disease. In this review, we include findings from related studies in T1DM and T2DM to highlight potential pathological mechanisms involved in initiation and progression of DEP, and to provide directions for future research studies.

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“…One study found it to be more prevalent than Type 1 DM (T1DM) 7 , and T3cDM accounts for 5-10% of diabetes in the western population 8 . Furthermore, there is a well-established relationship between diabetes and chronic pancreatitis 9 as well as pancreatic cancer 9,10 but there is more and more emerging evidence for the association of diabetes with AP 11 .…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Acute pancreatitis and diabetes mellitus: a review

Richardson

Park

2021

Korean J Intern Med

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Diabetes following acute pancreatitis (AP) is becoming increasingly recognized. It is unclear what subtype of diabetes mellitus (DM) occurs; however, type 3c diabetes mellitus (T3cDM) is gaining increasing recognition. T3cDM has differing pathophysiology than other subtypes of DM and therefore differing disease course and treatment. Current studies have examined the incidence and prevalence of DM following AP, and meta-analyses have shown around 15% develop DM at 1 year with an increasing proportion developing DM at 5 years. It has been observed that some patients have transient hyperglycemia following AP episode with a subset developing persistent impaired glucose metabolism; however, the exact timeline is not well defined. The data on risk factors for developing DM after AP is limited and mixed; however, it is likely that severity of AP may impact the propensity to develop DM. Screening guidelines have not been established following AP; however, screening 1-year post-event will likely capture a sizable proportion of newly developed DM. The endocrine and exocrine pancreas are closely linked, and studies have found significant overlap in dysfunction of both after AP. Finally, there are some data to suggest that diabetes predisposes patients to structural changes in the pancreas and increased risk of developing AP.

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Diabetes of the exocrine pancreas

Cited by 70 publications

References 65 publications

Ramadan and Diabetes: A Narrative Review and Practice Update

Ramadan and Diabetes: A Narrative Review and Practice Update

Pathological Mechanisms in Diabetes of the Exocrine Pancreas: What’s Known and What’s to Know

Acute pancreatitis and diabetes mellitus: a review

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