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. 2019 Jul-Aug;23(4):438-445.
doi: 10.4103/ijem.IJEM_214_19.

Prevalence of End-Organ Damage, Beta Cell Reserve, and Exocrine Pancreas Defect in Fibrocalculous Pancreatic Diabetes: An Eastern India Perspective

Beatrice Anne  1 , Sujoy Ghosh  2 , Ipsita Ghosh  2 , Sayantan Ray  3 , Subhankar Chowdhury  2 , Deep Dutta  4
Affiliations

Prevalence of End-Organ Damage, Beta Cell Reserve, and Exocrine Pancreas Defect in Fibrocalculous Pancreatic Diabetes: An Eastern India Perspective

Beatrice Anne et al. Indian J Endocrinol Metab. 2019 Jul-Aug.

Abstract

Background: Data on prevalence and burden of end-organ damage in fibrocalculous pancreatic diabetes (FCPD) from eastern India is scant. This study investigated the burden of end-organ damage and exocrine pancreatic defect in FCPD patients in Eastern India.

Materials and methods: Consecutive FCPD patients underwent evaluation of glycemic control, C-peptide, fecal elastase, body fat percent, tests for cardiac autonomic neuropathy (CAN), neuropathy, nephropathy, and retinopathy which were compared with data from type-1 diabetes (T1DM) and type-2 diabetes (T2DM).

Results: Data from 101 FCPD, 41 T1DM, 40 T2DM, and 40 controls were analyzed. Body fat percent was lowest in FCPD and T1DM. Similarly, fasting and stimulated C-peptide was significantly lowest in T1DM, followed by FCPD. Significant elevations in stimulated C-peptide were observed in FCPD. Fecal elastase was lowest in FCPD. Exocrine pancreas defect in FCPD, T1DM, and T2DM was 100%, 53.66%, 27.5%, respectively. HbA1c was worst in FCPD. About 40% of FCPD patients had CAN while 13.33% had borderline CAN. Isolated parasympathetic dysfunction was the commonest (66.67%) among them. FCPD patients with CAN had lower fecal elastase, higher HbA1c, microalbuminuria, steatorrhea, neuropathy, retinopathy, and nephropathy, compared to those without CAN. On binary logistic regression, diabetes duration was a significant predictor of end-organ damage in FCPD. Fecal elastase and body fat percent were independent predictors for insulin therapy in FCPD.

Conclusion: CAN is common in FCPD while exocrine pancreas defect is most severe in FCPD followed by T1DM and T2DM. Fecal elastase has an important prognostic role for insulinization in FCPD. Role of pancreatic enzyme replacement on glycemic control in diabetes with exocrine pancreas defect needs investigation.

Keywords: End-organ damage; exocrine defect; fibrocalculous pancreatic diabetes.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound showing features of chronic calcific pancreatitis (Main Pancreatic Duct MPD dilatation, intraductal calculus)
Figure 2
Figure 2
Pancreatic calculi removed during Frey's procedure from a patient with chronic calcific pancreatitis
Figure 3
Figure 3
X ray abdomen showing intraductal pancreatic calculi in a patient with Fibrocalculous pancreatic diabetes
See this image and copyright information in PMC

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