Pancreatic size and fat content in diabetes: A systematic review and meta-analysis of imaging studies

Abstract

ObjectivesImaging studies are expected to produce reliable information regarding the size and fat content of the pancreas. However, the available studies have produced inconclusive results. The aim of this study was to perform a systematic review and meta-analysis of imaging studies assessing pancreas size and fat content in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM).MethodsMedline and Embase databases were performed. Studies evaluating pancreatic size (diameter, area or volume) and/or fat content by ultrasound, computed tomography, or magnetic resonance imaging in patients with T1DM and/or T2DM as compared to healthy controls were selected. Seventeen studies including 3,403 subjects (284 T1DM patients, 1,139 T2DM patients, and 1,980 control subjects) were selected for meta-analyses. Pancreas diameter, area, volume, density, and fat percentage were evaluated.ResultsPancreatic volume was reduced in T1DM and T2DM vs. controls (T1DM vs. controls: -38.72 cm3, 95%CI: -52.25 to -25.19, I2 = 70.2%, p for heterogeneity = 0.018; and T2DM vs. controls: -12.18 cm3, 95%CI: -19.1 to -5.25, I2 = 79.3%, p for heterogeneity = 0.001). Fat content was higher in T2DM vs. controls (+2.73%, 95%CI 0.55 to 4.91, I2 = 82.0%, p for heterogeneity<0.001).ConclusionsIndividuals with T1DM and T2DM have reduced pancreas size in comparison with control subjects. Patients with T2DM have increased pancreatic fat content.

No acute pancreatitis but reduced exocrine pancreatic function at diagnosis of type 1 diabetes in children

“…The paradigm of T1D as a pure consequence of an autoimmune process has been questioned, both because of the failure to treat the disease with different immune interventions, but also when it has been found that the insulitis is neither common nor pronounced. Similar inflammatory cells are found also in exocrine pancreas, and the whole organ is decreased in size with different structural changes . Furthermore, it is found that the exocrine function decreases gradually in individuals already before they get manifest T1D, and exocrine function is decreased in many children with T1D .…”

“…In addition, studies show that pancreas often is smaller in patients who develop T1D, although the same smaller size also is seen in first‐degree relatives of patients with T1D …”

Connecting pancreatic islet lipid metabolism with insulin secretion and the development of type 2 diabetes

“…1 Indeed, many human studies, including those with prediabetes, have demonstrated that the concentration of FA in circulation negatively correlates with parameters of beta cell function in both adults and youths from different ethnic populations; 82-84 however, it should be noted that absence of a correlation between the two has also been reported. 87,88 Although it is not established whether pancreatic fat accumulation is sufficient for the development of beta cell dysfunction, or if reduction of pancreatic fat reverses beta cell dysfunction in humans, 89-91 local fat accumulation is a possible source of lipids that affect beta cell health in humans. Historically, lipotoxicity as a precipitating factor for beta cell failure was first proposed in a rodent model of T2D in which the accumulation of pancreatic fat precedes beta cell dysfunction.…”

Comparison of pancreatic volume and fat amount linked with glucose homeostasis between healthy Caucasians and Koreans

“…Another study also showed that pancreatic volume was smaller in people with maturity‐onset diabetes of the young than in controls . In a meta‐analysis using ultrasonography, CT or MRI, pancreatic volume was reduced in people with T2D compared with healthy controls by 12.180 cm, 3 and fat content was higher in people with diabetes than in controls by 2.73% (95% CI 0.55‐4.91) …”

“…Inclusion criteria for white participants were: non-Hispanic white ethnicity; age [25][26][27][28][29][30][31][32][33][34][35] We recruited white participants first, followed by Korean participants to match age and BMI. We screened 56 white people.…”