Exocrine Pancreatic Insufficiency in Diabetes Mellitus: A Complication of Diabetic Neuropathy or a Different Type of Diabetes?

Hardt, Philip D.; Ewald, Nils

doi:10.1155/2011/761950

Cited by 102 publications

(91 citation statements)

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“…Chronic inflammatory changes of the exocrine pancreas was shown in diabetic patients [20]. Autopsy studies and studies on pancreas histology showed marked changes in the exocrine gland in patients with diabetes mellitus [21]. …”

Section: Discussionmentioning

confidence: 99%

The effect of glycemic control on CEA, CA 19-9, amylase and lipase levels

et al. 2014

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BackgroundDiabetes mellitus is closely related to pancreas cancer. In this study we aimed to investigate the effect of hyperglycemia on tumor and inflammation markers, as well as pancreatic exocrine functions.MethodsA total of 98 consecutive diabetic patients with poor glycemic control, and 50 healthy controls were included in the study. We measured hsCRP, erythrocyte sedimentation rate (ESR), CA19-9, CEA, amylase and lipase in addition to routine biochemistry tests, before and after euglycemia was achieved.ResultsFasting blood glucose, HbA1c, CA19-9, CEA, hsCRP, ESR, triglycerides, AST, ALT, GGT, ALP, total cholesterol and LDL-C levels decreased significantly with the regulation of glycemic control. Amylase and lipase levels increased with the regulation of glycemic control. After glycemic control, CA19-9 and CEA levels were still higher, whereas amylase and lipase levels were still lower in the diabetic group compared with the control group. Basal HbA1c showed significant correlation with CA19-9, CEA, amylase and lipase.ConclusionsWe propose to repeat observations of tumor markers after hyperglycemia is resolved, in order to avoid unnecessary invasive tests. Our data also suggest that pancreatic exocrine function was improved with lowering blood glucose in a short period of time.

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Section: Discussionmentioning

confidence: 99%

The effect of glycemic control on CEA, CA 19-9, amylase and lipase levels

et al. 2014

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“…4–9 It has been known for more than a century that there are significant changes in exocrine pancreas in patients presenting with types 1 and 2 DM. 10 Because of both structural and functional changes in the exocrine pancreas in types 1 and 2 DM, some authors have speculated that these changes represent CP.…”

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confidence: 99%

“…10 Because of both structural and functional changes in the exocrine pancreas in types 1 and 2 DM, some authors have speculated that these changes represent CP. 4,10–12 Because DM is not associated with clinical symptoms of exocrine pancreatic disease, it is postulated that the changes may represent silent CP. 4 …”

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confidence: 99%

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Diabetes Mellitus Is Associated With an Exocrine Pancreatopathy

et al. 2016

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Objective Abnormalities in exocrine pancreatic function have been reported in diabetes mellitus (DM). We reviewed published literature to determine the nature of structural and functional alterations in the exocrine pancreas in DM. Methods We identified and abstracted data from original studies (n = 50) describing morphological, structural, and functional changes in the exocrine pancreas in types 1 and 2 DM. Results Pancreatic weight and volume are markedly lower in type 1 DM (P < 0.005) with insignificant decrease in type 2 DM compared with age-, sex-, and body mass index–matched controls. Pancreatic histopathological changes seen in most subjects with DM at autopsy (n = 7 studies, 1272 autopsies) include mild-to-marked interacinar fibrosis, scant inflammatory infiltrate, no pancreatic ductal changes, and hyalinization of arteries. In subjects with DM, pooled prevalence of decreased fecal elastase 1 (<200 μg/g) is higher, coefficient of fat absorption is near normal (mean, 91%–94%), and pancreatic exocrine dysfunction is nonprogressive over time. Diabetes mellitus is asymptomatic in regard to the exocrine pancreas. Conclusions In types 1 and 2 DM, moderate-to-severe subclinical pancreatic fibrosis and modest exocrine dysfunction occurs in the absence of clinical or histopathological evidence of chronic pancreatitis. We call this novel entity “diabetic exocrine pancreatopathy.”

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“…This also is a syndrome associated with T1DM and T2DM (Hardt & Ewald, 2011). Pancreatic insufficiency is the syndrome that results from a deficiency in pancreatic enzymes that are required to properly digest food.…”

Section: Assessmentmentioning

confidence: 99%

Management of Diabetes and Pancreatic Cancer

Flaherty¹

2012

Oncology Nursing Forum

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A 54-year-old male patient named D.N. developed type 2 diabetes mellitus (T2DM) 10 months ago. At the time, he weighed 225 pounds and had a body mass index of 35.2. D.N. was started on metformin with poor control and, within two months, glimepiride was added to his regimen. Six months later, D.N.'s hemoglobin A1c (HbA1c) was still above 8% (normal is less than 6%), so his endocrinologist added exenatide. He had a fairly well controlled fasting blood glucose and HbA1c ranging from 6.5%-7.3% after exenatide was added. One month later, however, D.N. developed abdominal pain and anorexia with a 20-pound weight loss. His blood glucose became extremely labile despite his poor oral intake and good compliance with his oral hypoglycemic agents.A few days later, D.N. presented to the emergency room with severe abdominal pain and difficulty eating. An abdominal ultrasound revealed a normal pancreas, but a computed tomography (CT) scan showed evidence of pancreatitis and a possible mass in the tail of the pancreas. D.N. was first treated for pancreatitis and then underwent an endoscopic ultrasound that revealed an irregular partially cystic mass that was 2 x 3 cm in size. Multiple biopsies showed atypical cells. A distal pancreatectomy was performed and pathology revealed pancreatic intraepithelial neoplasia with high-grade dysplasia with a question of invasive adenocarcinoma; findings by two independent pathologists were inconclusive. Thirteen peripancreatic lymph nodes were negative for metastatic tumor. D.N. was observed for two months and a repeat CT scan revealed a recurrent mass in the pancreatic surgical bed with invasion of the hepatic artery and superior mesenteric vein. An ultrasound-guided biopsy confirmed adenocarcinoma, and D.N. was referred to a medical oncologist for treatment options. Diabetes management also was very difficult at this point as his blood glucose was consistently greater than 300 mg/dl (normal is less than 125 mg/dl) despite oral medications and a 70-pound weight loss. Pancreatic insufficiency caused by his surgery and disease resulted in chronic diarrhea and further malnutrition.The decision was made with the patient and family to initiate fluorouracil, leucovorin, and oxaliplatin chemotherapy. This regimen presented a few challenges because oxaliplatin and all supportive fluids are mixed in dextrose and the recommended antiemetic regimen includes dexamethasone, a glucocorticoid. This combination puts additional burden on glucose metabolism.Although nausea can be fairly well controlled, anorexia and taste changes can reduce caloric intake and affect insulin and oral hypoglycemic medication requirements. D.N. tolerated the first cycle well with minimal nausea, but his blood sugar rose above 500 mg/dl and his lactic acid level was elevated; therefore, he was hospitalized for stabilization of his glucose. Working with his endocrinologist, D.N. was initiated on a regimen with sliding scale regular insulin (humulin) and metformin, which helped maintain glucose control.

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Exocrine Pancreatic Insufficiency in Diabetes Mellitus: A Complication of Diabetic Neuropathy or a Different Type of Diabetes?

Cited by 102 publications

References 53 publications

The effect of glycemic control on CEA, CA 19-9, amylase and lipase levels

The effect of glycemic control on CEA, CA 19-9, amylase and lipase levels

Diabetes Mellitus Is Associated With an Exocrine Pancreatopathy

Management of Diabetes and Pancreatic Cancer

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