DESCRIPTION: Diabetes and glucose intolerance are common complications of chronic pancreatitis, yet clinical guidance on their detection, classification, and management is lacking. METHODS: A working group reviewed the medical problems, diagnostic methods, and treatment options for chronic pancreatitis-associated diabetes for a consensus meeting at PancreasFest 2012. RESULTS: Guidance Statement 1.1: Diabetes mellitus is common in chronic pancreatitis. While any patient with chronic pancreatitis should be monitored for development of diabetes, those with long-standing duration of disease, prior partial pancreatectomy, and early onset of calcific disease may be at higher risk. Those patients developing diabetes mellitus are likely to have co-existing pancreatic exocrine insufficiency. Guidance Statement 1.2: Diabetes occurring secondary to chronic pancreatitis should be recognized as pancreatogenic diabetes (type 3c diabetes). Guidance Statement 2.1: The initial evaluation should include fasting glucose and HbA1c. These tests should be repeated annually. Impairment in either fasting glucose or HbA1c requires further evaluation. Guidance Statement 2.2: Impairment in either fasting glucose or HbA1c should be further evaluated by a standard 75 g oral glucose tolerance test. Guidance Statement 2.3: An absent pancreatic polypeptide response to mixed-nutrient ingestion is a specific indicator of type 3c diabetes. Guidance Statement 2.4: Assessment of pancreatic endocrine reserve, and importantly that of functional beta-cell mass, should be performed as part of the evaluation and follow-up for total pancreatectomy with islet autotransplantation (TPIAT). Guidance Statement 3: Patients with pancreatic diabetes shall be treated with specifically tailored medical nutrition and pharmacologic therapies. CONCLUSIONS: Physicians should evaluate and treat glucose intolerance in patients with pancreatitis.
DESCRIPTION: Diabetes and glucose intolerance are common complications of chronic pancreatitis, yet clinical guidance on their detection, classification, and management is lacking. METHODS: A working group reviewed the medical problems, diagnostic methods, and treatment options for chronic pancreatitis-associated diabetes for a consensus meeting at PancreasFest 2012. RESULTS: Guidance Statement 1.1: Diabetes mellitus is common in chronic pancreatitis. While any patient with chronic pancreatitis should be monitored for development of diabetes, those with long-standing duration of disease, prior partial pancreatectomy, and early onset of calcific disease may be at higher risk. Those patients developing diabetes mellitus are likely to have co-existing pancreatic exocrine insufficiency. Guidance Statement 1.2: Diabetes occurring secondary to chronic pancreatitis should be recognized as pancreatogenic diabetes (type 3c diabetes). Guidance Statement 2.1: The initial evaluation should include fasting glucose and HbA1c. These tests should be repeated annually. Impairment in either fasting glucose or HbA1c requires further evaluation. Guidance Statement 2.2: Impairment in either fasting glucose or HbA1c should be further evaluated by a standard 75 g oral glucose tolerance test. Guidance Statement 2.3: An absent pancreatic polypeptide response to mixed-nutrient ingestion is a specific indicator of type 3c diabetes. Guidance Statement 2.4: Assessment of pancreatic endocrine reserve, and importantly that of functional beta-cell mass, should be performed as part of the evaluation and follow-up for total pancreatectomy with islet autotransplantation (TPIAT). Guidance Statement 3: Patients with pancreatic diabetes shall be treated with specifically tailored medical nutrition and pharmacologic therapies. CONCLUSIONS: Physicians should evaluate and treat glucose intolerance in patients with pancreatitis.
Authors: Sunil G Sheth; Darwin L Conwell; David C Whitcomb; Matthew Alsante; Michelle A Anderson; Jamie Barkin; Randall Brand; Gregory A Cote; Steven D Freedman; Andres Gelrud; Fred Gorelick; Linda S Lee; Katherine Morgan; Stephen Pandol; Vikesh K Singh; Dhiraj Yadav; C Mel Wilcox; Phil A Hart Journal: Pancreatology Date: 2017-02-28 Impact factor: 3.996
Authors: Rachel Lundberg; Gregory J Beilman; Ty B Dunn; Tim L Pruett; Martin L Freeman; Peggy E Ptacek; Katherine Louise Berry; R Paul Robertson; Antoinette Moran; Melena D Bellin Journal: Pancreas Date: 2016-04 Impact factor: 3.327
Authors: Phil A Hart; Melena D Bellin; Dana K Andersen; David Bradley; Zobeida Cruz-Monserrate; Christopher E Forsmark; Mark O Goodarzi; Aida Habtezion; Murray Korc; Yogish C Kudva; Stephen J Pandol; Dhiraj Yadav; Suresh T Chari Journal: Lancet Gastroenterol Hepatol Date: 2016-10-12
Authors: Aliye Uc; Dana K Andersen; Melena D Bellin; Jason I Bruce; Asbjørn M Drewes; John F Engelhardt; Christopher E Forsmark; Markus M Lerch; Mark E Lowe; Brent A Neuschwander-Tetri; Stephen J OʼKeefe; Tonya M Palermo; Pankaj Pasricha; Ashok K Saluja; Vikesh K Singh; Eva M Szigethy; David C Whitcomb; Dhiraj Yadav; Darwin L Conwell Journal: Pancreas Date: 2016-11 Impact factor: 3.327
Authors: Melena D Bellin; Martin L Freeman; Andres Gelrud; Adam Slivka; Alfred Clavel; Abhinav Humar; Sarah J Schwarzenberg; Mark E Lowe; Michael R Rickels; David C Whitcomb; Jeffrey B Matthews; Stephen Amann; Dana K Andersen; Michelle A Anderson; John Baillie; Geoffrey Block; Randall Brand; Suresh Chari; Marie Cook; Gregory A Cote; Ty Dunn; Luca Frulloni; Julia B Greer; Michael A Hollingsworth; Kyung Mo Kim; Alexander Larson; Markus M Lerch; Tom Lin; Thiruvengadam Muniraj; R Paul Robertson; Seth Sclair; Shalinender Singh; Rachelle Stopczynski; Frederico G S Toledo; Charles Melbern Wilcox; John Windsor; Dhiraj Yadav Journal: Pancreatology Date: 2013-11-13 Impact factor: 3.996