Chronic Calcific Pancreatitis and Diabetes Mellitus: Hidden Pathogenetic Mechanisms and Clinical Significance

Le résumé fourni par la source

Aim. To assess carbohydrate metabolism in patients with chronic calcific pancreatitis (CCP), analyze the relationship between endocrine and exocrine pancreatic insufficiency, and determine its clinical significance for the diagnosis and management of diabetes mellitus in this patient population. Design. A mixed retrospective and prospective comparative cohort study. Materials and methods. The study included 189 patients with confirmed CCP, comprising a prospective group (n = 51) and a retrospective group (n = 138). Carbohydrate metabolism was assessed using blood glucose levels, glycated hemoglobin, C-peptide, free insulin, glucagon, oral glucose tolerance test results, and mixed meal test results. Exocrine pancreatic function was evaluated by measuring fecal pancreatic elastase-1 (PE-1). Results. Only 31.2% of patients had normal carbohydrate metabolism, whereas 68.8% were diagnosed with prediabetes or different types of diabetes mellitus. Exocrine insufficiency of varying severity was detected in 53.3% of patients with a verified diagnosis of CCP lasting at least five years. All patients with severe exocrine insufficiency had insulin-requiring diabetes mellitus. Patients with severe PE-1 deficiency had markedly reduced insulin-secreting capacity, which was confirmed by the mixed meal test. Administration of adequate doses of pancreatic enzyme replacement therapy led to an increase in insulin requirements to levels close to physiological. Conclusion. CCP is associated with a marked decrease in both exocrine and endocrine pancreatic function. All patients with CCP require annual metabolic screening, and patients with symptoms of malabsorption should undergo fecal PE-1 assessment and correction of enzyme insufficiency.

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