TY - JOUR
T1 - Natural history of endocrine failure in tropical chronic pancreatitis
T2 - A longitudinal follow-up study
AU - Mohan, Viswanathan
AU - Barman, Karuna Kanta
AU - Rajan, Venkata Subbarao
AU - Chari, Suresh T.
AU - Deepa, Raj
PY - 2005/12
Y1 - 2005/12
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.
KW - Diabetes
KW - Fibrocalculous pancreatic diabetes
KW - Natural history
KW - Tropical chronic pancreatitis
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U2 - 10.1111/j.1440-1746.2005.04068.x
DO - 10.1111/j.1440-1746.2005.04068.x
M3 - Article
C2 - 16336455
AN - SCOPUS:33644873238
SN - 0815-9319
VL - 20
SP - 1927
EP - 1934
JO - Journal of Gastroenterology and Hepatology (Australia)
JF - Journal of Gastroenterology and Hepatology (Australia)
IS - 12
ER -