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Chronic pancreatitis and diabetes.

H Sarles1

  • 1Unité de Recherches de Physiologie et Pathologie Digestives, INSERUM U 315-46, Marseille, France.

Bailliere'S Clinical Endocrinology and Metabolism
|October 1, 1992
PubMed
Summary

Chronic pancreatitis involves pancreatic fibrosis and often leads to diabetes. Chronic calcifying pancreatitis, linked to alcohol or malnutrition, is the most common form, with diabetes appearing late in its progression.

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Area of Science:

  • Gastroenterology
  • Endocrinology
  • Pathology

Background:

  • Chronic pancreatitis is characterized by persistent pancreatic destruction and fibrosis, initially affecting the exocrine gland before involving islets.
  • The most prevalent form is chronic calcifying pancreatitis (CCP), a pancreatic lithiasis accounting for over 95% of cases, often linked to alcohol, tobacco, and malnutrition.

Purpose of the Study:

  • To describe the etiology, pathogenesis, clinical presentation, and complications of chronic pancreatitis, with a focus on its relationship with diabetes.
  • To differentiate between chronic calcifying pancreatitis and obstructive pancreatitis and their respective impacts on diabetes development.

Main Methods:

  • Review of existing literature on chronic pancreatitis, its subtypes, and associated diabetes.
  • Analysis of the pathogenesis of calcium precipitation in pancreatic juice and the role of lithostathine.
  • Characterization of diabetes in chronic pancreatitis patients, including metabolic profiles and complications.

Main Results:

  • Chronic calcifying pancreatitis involves calculi primarily composed of calcium salts and degraded lithostathine, influenced by environmental factors like alcohol and diet.
  • Diabetes in chronic pancreatitis typically emerges after recurrent abdominal pain and elevated pancreatic enzymes, often with pain cessation upon diabetes onset.
  • Diabetes associated with chronic pancreatitis exhibits low ketosis, high risk of insulin-induced hypoglycemia, decreased insulin levels, and fewer microvascular complications compared to type 2 diabetes.

Conclusions:

  • Chronic pancreatitis, particularly the calcifying form, is a significant cause of diabetes with distinct clinical and metabolic characteristics.
  • Understanding the pathogenesis and clinical course is crucial for managing diabetes in chronic pancreatitis patients, often requiring insulin therapy.
  • Obstructive pancreatitis is less commonly associated with diabetes, highlighting the specific mechanisms linking pancreatic damage to glucose dysregulation.

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