High Rate of Exocrine Pancreatic Dysfunction in Pediatric Patients with Diabetes Mellitus

This study aimed to describe the frequency of exocrine pancreatic disease in youth with diabetes.

We conducted a retrospective chart review on data that was obtained from a single-center prospectively collected database of patients with diabetes. Patients were categorized as having type 1 diabetes, type 2 diabetes, or "Other" diabetes if they had cystic fibrosis-related diabetes, maturity-onset diabetes of the young, or drug/chemical-induced diabetes. All patients' charts were reviewed for exocrine pancreas disease, inclusive of pancreatitis or exocrine pancreatic insufficiency.

Nine hundred eighty-eight patients with a diabetes diagnosis were included. Thirty-five out of 988 (3.5%) were diagnosed with pancreatic exocrine disease. Diabetes patients with exocrine disease compared with the ones without were significantly older (13.1 y, IQR 9.8-15.3 vs. 11.7 y, P = 0.04). Those with exocrine disease were more likely to have "Other" diabetes ( P <0.0001). The exocrine group had a lower median hemoglobin A1c at diabetes diagnosis (7%, IQR 5.8%-9.2% vs. 11.3%, 8.9%-13.8%; P <0.0001). Out of the 988 patients, 18 patients had pancreatitis diagnosed, which was 2% of the overall cohort. Nine of the 18 patients were found to have developed pancreatitis after diabetes diagnosis, or 1% of the entire diabetes cohort (9/988).

The co-existence of exocrine and endocrine pancreatic disease occurred in 3.5% of diabetes patients. The risk of pancreatitis occurring after diabetes was 1%, a rate 100 times higher than the general pediatric population (0.01%). Future studies are needed to determine the specific mechanisms involved in the connection between endocrine and exocrine pancreatic disease in children.