Natural history of endocrine failure in tropical chronic pancreatitis: A longitudinal follow-up study

Viswanathan Mohan, Karuna Kanta Barman, Venkata Subbarao Rajan, Suresh T Chari, Raj Deepa

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background and Aims: Diabetes in tropical chronic pancreatitis (TCP), also known as fibrocalculous pancreatic diabetes (FCPD), is frequently seen at diagnosis. The aim of the present study was to determine the natural history of endocrine failure in TCP subjects without diabetes at baseline. Methods: Of 73 TCP subjects without diabetes according to World Health Organization (WHO) criteria at baseline who were seen at an out-patient center, 54 (74.0%) underwent periodic oral glucose tolerance tests on follow up. Another 54 sex-matched, non-diabetic subjects without chronic pancreatitis served as controls. Baseline demographic and clinical characteristics were noted. Results: After a median follow up of 5.0 years in TCP subjects and 7.0 years in controls, 27 of 54 TCP subjects (50%) developed diabetes compared with 14 of 54 controls (25.9%). Of the TCP subjects, those who developed diabetes on follow up were older (31 ± 12 vs 23 ± 11 years; P = 0.013), had a higher body mass index (21.7 ± 4.4 vs 18.2 ± 3.5 kg/m2; P = 0.004), higher 2 h post-load plasma glucose (8.8 ± 1.9 vs 6.7 ± 1.4 mmol/L; P < 0.001) and lower fecal chymotrypsin (2.1 ± 1.2 vs 4.3 ± 2.5 U/g; P < 0.001) at baseline compared with those who did not develop diabetes. The median time for the development of diabetes after diagnosis of TCP was 9.6 years (compared with 14.4 years among controls). Only 2 of 13 TCP subjects (15.4%) who had undergone surgical interventions during the normal glucose tolerance phase developed diabetes during follow up. Conclusions: In TCP, there is progressive deterioration of endocrine pancreatic function, with development of diabetes in 50% of patients upon follow up, suggesting that FCPD is merely a later stage in the course of TCP. Early surgery may prevent the development of diabetes in TCP subjects.

Original languageEnglish (US)
Pages (from-to)1927-1934
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume20
Issue number12
DOIs
StatePublished - 2005

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Chronic Pancreatitis
Natural History
Glucose
Chymotrypsin
Glucose Tolerance Test
Body Mass Index
Outpatients
Demography

Keywords

  • Diabetes
  • Fibrocalculous pancreatic diabetes
  • Natural history
  • Tropical chronic pancreatitis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Natural history of endocrine failure in tropical chronic pancreatitis : A longitudinal follow-up study. / Mohan, Viswanathan; Barman, Karuna Kanta; Rajan, Venkata Subbarao; Chari, Suresh T; Deepa, Raj.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 20, No. 12, 2005, p. 1927-1934.

Research output: Contribution to journalArticle

Mohan, Viswanathan ; Barman, Karuna Kanta ; Rajan, Venkata Subbarao ; Chari, Suresh T ; Deepa, Raj. / Natural history of endocrine failure in tropical chronic pancreatitis : A longitudinal follow-up study. In: Journal of Gastroenterology and Hepatology (Australia). 2005 ; Vol. 20, No. 12. pp. 1927-1934.
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abstract = "Background and Aims: Diabetes in tropical chronic pancreatitis (TCP), also known as fibrocalculous pancreatic diabetes (FCPD), is frequently seen at diagnosis. The aim of the present study was to determine the natural history of endocrine failure in TCP subjects without diabetes at baseline. Methods: Of 73 TCP subjects without diabetes according to World Health Organization (WHO) criteria at baseline who were seen at an out-patient center, 54 (74.0{\%}) underwent periodic oral glucose tolerance tests on follow up. Another 54 sex-matched, non-diabetic subjects without chronic pancreatitis served as controls. Baseline demographic and clinical characteristics were noted. Results: After a median follow up of 5.0 years in TCP subjects and 7.0 years in controls, 27 of 54 TCP subjects (50{\%}) developed diabetes compared with 14 of 54 controls (25.9{\%}). Of the TCP subjects, those who developed diabetes on follow up were older (31 ± 12 vs 23 ± 11 years; P = 0.013), had a higher body mass index (21.7 ± 4.4 vs 18.2 ± 3.5 kg/m2; P = 0.004), higher 2 h post-load plasma glucose (8.8 ± 1.9 vs 6.7 ± 1.4 mmol/L; P < 0.001) and lower fecal chymotrypsin (2.1 ± 1.2 vs 4.3 ± 2.5 U/g; P < 0.001) at baseline compared with those who did not develop diabetes. The median time for the development of diabetes after diagnosis of TCP was 9.6 years (compared with 14.4 years among controls). Only 2 of 13 TCP subjects (15.4{\%}) who had undergone surgical interventions during the normal glucose tolerance phase developed diabetes during follow up. Conclusions: In TCP, there is progressive deterioration of endocrine pancreatic function, with development of diabetes in 50{\%} of patients upon follow up, suggesting that FCPD is merely a later stage in the course of TCP. Early surgery may prevent the development of diabetes in TCP subjects.",
keywords = "Diabetes, Fibrocalculous pancreatic diabetes, Natural history, Tropical chronic pancreatitis",
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AU - Barman, Karuna Kanta

AU - Rajan, Venkata Subbarao

AU - Chari, Suresh T

AU - Deepa, Raj

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N2 - Background and Aims: Diabetes in tropical chronic pancreatitis (TCP), also known as fibrocalculous pancreatic diabetes (FCPD), is frequently seen at diagnosis. The aim of the present study was to determine the natural history of endocrine failure in TCP subjects without diabetes at baseline. Methods: Of 73 TCP subjects without diabetes according to World Health Organization (WHO) criteria at baseline who were seen at an out-patient center, 54 (74.0%) underwent periodic oral glucose tolerance tests on follow up. Another 54 sex-matched, non-diabetic subjects without chronic pancreatitis served as controls. Baseline demographic and clinical characteristics were noted. Results: After a median follow up of 5.0 years in TCP subjects and 7.0 years in controls, 27 of 54 TCP subjects (50%) developed diabetes compared with 14 of 54 controls (25.9%). Of the TCP subjects, those who developed diabetes on follow up were older (31 ± 12 vs 23 ± 11 years; P = 0.013), had a higher body mass index (21.7 ± 4.4 vs 18.2 ± 3.5 kg/m2; P = 0.004), higher 2 h post-load plasma glucose (8.8 ± 1.9 vs 6.7 ± 1.4 mmol/L; P < 0.001) and lower fecal chymotrypsin (2.1 ± 1.2 vs 4.3 ± 2.5 U/g; P < 0.001) at baseline compared with those who did not develop diabetes. The median time for the development of diabetes after diagnosis of TCP was 9.6 years (compared with 14.4 years among controls). Only 2 of 13 TCP subjects (15.4%) who had undergone surgical interventions during the normal glucose tolerance phase developed diabetes during follow up. Conclusions: In TCP, there is progressive deterioration of endocrine pancreatic function, with development of diabetes in 50% of patients upon follow up, suggesting that FCPD is merely a later stage in the course of TCP. Early surgery may prevent the development of diabetes in TCP subjects.

AB - Background and Aims: Diabetes in tropical chronic pancreatitis (TCP), also known as fibrocalculous pancreatic diabetes (FCPD), is frequently seen at diagnosis. The aim of the present study was to determine the natural history of endocrine failure in TCP subjects without diabetes at baseline. Methods: Of 73 TCP subjects without diabetes according to World Health Organization (WHO) criteria at baseline who were seen at an out-patient center, 54 (74.0%) underwent periodic oral glucose tolerance tests on follow up. Another 54 sex-matched, non-diabetic subjects without chronic pancreatitis served as controls. Baseline demographic and clinical characteristics were noted. Results: After a median follow up of 5.0 years in TCP subjects and 7.0 years in controls, 27 of 54 TCP subjects (50%) developed diabetes compared with 14 of 54 controls (25.9%). Of the TCP subjects, those who developed diabetes on follow up were older (31 ± 12 vs 23 ± 11 years; P = 0.013), had a higher body mass index (21.7 ± 4.4 vs 18.2 ± 3.5 kg/m2; P = 0.004), higher 2 h post-load plasma glucose (8.8 ± 1.9 vs 6.7 ± 1.4 mmol/L; P < 0.001) and lower fecal chymotrypsin (2.1 ± 1.2 vs 4.3 ± 2.5 U/g; P < 0.001) at baseline compared with those who did not develop diabetes. The median time for the development of diabetes after diagnosis of TCP was 9.6 years (compared with 14.4 years among controls). Only 2 of 13 TCP subjects (15.4%) who had undergone surgical interventions during the normal glucose tolerance phase developed diabetes during follow up. Conclusions: In TCP, there is progressive deterioration of endocrine pancreatic function, with development of diabetes in 50% of patients upon follow up, suggesting that FCPD is merely a later stage in the course of TCP. Early surgery may prevent the development of diabetes in TCP subjects.

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KW - Tropical chronic pancreatitis

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