Distinguishing diabetes secondary to pancreatic diseases from type 2 diabetes mellitus

Hart, Phil A.; Andersen, Dana K.; Petrov, Maxim S.; Goodarzi, Mark O.

doi:10.1097/mog.0000000000000754

Cited by 14 publications

(11 citation statements)

References 54 publications

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“…Taken together, the two studies suggest that chronic pancreatitis and diabetes have multiplicative effect on the risk of developing pancreatic cancer. This may increase the effectiveness of screening for pancreatic cancer in the future, as outlined in the companion article in this issue of the Journal [26].…”

Section: Natural History Of Diabetes In the Course Of Chronic Pancrea...mentioning

confidence: 99%

Diabetes in chronic pancreatitis: risk factors and natural history

Goodarzi¹,

Petrov

Andersen

et al. 2021

Current Opinion in Gastroenterology

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Purpose of review The purpose of this review is to delineate risk factors for the development of diabetes in patients with chronic pancreatitis. The natural history including progression to diabetes and complications that develop once diabetes occurs in chronic pancreatitis is also reviewed. Recent findings Studies have found that predictors of diabetes in chronic pancreatitis include both risk factors for type 2 diabetes (e.g., obesity, genetic variants) as well as pancreas-specific factors (e.g., pancreatic calcification, exocrine insufficiency). Rates of diabetes in chronic pancreatitis are strongly related to the duration of chronic pancreatitis, reflecting progressive dysfunction and damage to the insulin-secreting beta cells. Patients with diabetes and chronic pancreatitis experience an excess burden of complications, including higher all-cause and cancer-related mortality. Summary The high incidence and significant impact of diabetes on the morbidity and mortality of patients with chronic pancreatitis highlights the urgent need for clinically applicable models to predict diabetes in those with chronic pancreatitis, allowing efforts for targeted interventions to prevent diabetes. Research being carried out in the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer holds promise to fulfill these goals.

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Section: Natural History Of Diabetes In the Course Of Chronic Pancrea...mentioning

confidence: 99%

Diabetes in chronic pancreatitis: risk factors and natural history

Goodarzi¹,

Petrov

Andersen

et al. 2021

Current Opinion in Gastroenterology

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“…This is problematic as pancreatogenic diabetes has been associated with poor glycemic control, increased insulin requirements, frequent hypoglycemic episodes, and excess mortality compared with type 2 diabetes [33,34 ▪▪ ,35]. Thus, individuals with pancreatogenic diabetes seem to have special requirements for management, which underlines the importance of distinguishing it from other diabetes subtypes [19]. The field, however, is hampered by a lack of specific biomarkers and there is currently a number of initiatives working to close this knowledge gap [19,22,36].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, individuals with pancreatogenic diabetes seem to have special requirements for management, which underlines the importance of distinguishing it from other diabetes subtypes [19]. The field, however, is hampered by a lack of specific biomarkers and there is currently a number of initiatives working to close this knowledge gap [19,22,36].…”

Section: Discussionmentioning

confidence: 99%

“…The observation of substantially increased risk for diabetes after mild acute pancreatitis suggests the possibility that the pathogenesis of diabetes after acute pancreatitis involves mechanisms beyond pancreatic necrosis and loss of pancreatic islet cells [1,2]. There have been reports suggesting that some patients have insulin resistance after an episode of acute pancreatitis [9 ▪ ,19,20]. This may be mediated by chronic low-grade inflammation, altered secretion of intestinal hormones, lipolysis, and changes in iron metabolism, which together with beta cell loss and impaired insulin secretion, all have been suggested to contribute to the decompensation of glucose metabolism in acute pancreatitis-related diabetes [18,21,22].…”

Section: The Spectrum Of Diabetes In Pancreatitismentioning

confidence: 99%

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The spectrum of diabetes in acute and chronic pancreatitis

Olesen

Toledo

Hart

2022

Current Opinion in Gastroenterology

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Purpose of reviewTo discuss the spectrum of diabetes related to acute and chronic pancreatitis (which are types of pancreatogenic diabetes) and its overlapping features with type 1 and type 2 diabetes.Recent findingsPatients with diabetes related to acute and chronic pancreatitis present clinically within a spectrum of overlapping features with other forms of diabetes. In this spectrum, glucose metabolism alterations range from increased insulin resistance following acute pancreatitis (resembling type 2 diabetes) towards a permanent loss of beta-cell function and impaired insulin secretion in end-stage chronic pancreatitis. Overlapping features with type 1 diabetes (beta cell autoantibodies) and type 2 diabetes (obesity, dyslipidemia, and hereditary/genetic factors) contribute to the heterogeneity of this spectrum.SummaryPancreatogenic diabetes secondary to acute or chronic pancreatitis is a heterogeneous entity with a variable clinical presentation, including many cases that are misdiagnosed and treated as type 2 diabetes. This is problematic as pancreatogenic diabetes is associated with a poor prognosis and entails special considerations for management. Recent discoveries showing overlapping features with type 1 and type 2 diabetes along with an improved understanding of its pathophysiology are expected to improve the diagnosis and treatment of these and other forms of pancreatogenic diabetes.

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“…However, PPDM-A has not drawn sufficient attention and has often been misdiagnosed as T2DM 12 , 16 . Diabetes mellitus is highly heterogeneous and requires fine diagnostic staging for precise treatment.…”

Section: Introductionmentioning

confidence: 99%

Machine learning for post-acute pancreatitis diabetes mellitus prediction and personalized treatment recommendations

Zhang

Hou

et al. 2023

Sci Rep

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Post-acute pancreatitis diabetes mellitus (PPDM-A) is the main component of pancreatic exocrine diabetes mellitus. Timely diagnosis of PPDM-A improves patient outcomes and the mitigation of burdens and costs. We aimed to determine risk factors prospectively and predictors of PPDM-A in China, focusing on giving personalized treatment recommendations. Here, we identify and evaluate the best set of predictors of PPDM-A prospectively using retrospective data from 820 patients with acute pancreatitis at four centers by machine learning approaches. We used the L1 regularized logistic regression model to diagnose early PPDM-A via nine clinical variables identified as the best predictors. The model performed well, obtaining the best AUC = 0.819 and F1 = 0.357 in the test set. We interpreted and personalized the model through nomograms and Shapley values. Our model can accurately predict the occurrence of PPDM-A based on just nine clinical pieces of information and allows for early intervention in potential PPDM-A patients through personalized analysis. Future retrospective and prospective studies with multicentre, large sample populations are needed to assess the actual clinical value of the model.

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Distinguishing diabetes secondary to pancreatic diseases from type 2 diabetes mellitus

Cited by 14 publications

References 54 publications

Diabetes in chronic pancreatitis: risk factors and natural history

Diabetes in chronic pancreatitis: risk factors and natural history

The spectrum of diabetes in acute and chronic pancreatitis

Machine learning for post-acute pancreatitis diabetes mellitus prediction and personalized treatment recommendations

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