期刊
PANCREATOLOGY
卷 13, 期 4, 页码 336-342出版社
ELSEVIER
DOI: 10.1016/j.pan.2013.05.002
关键词
Diabetes mellitus; Chronic pancreatitis; Incretin; Pancreatogenic diabetes; Insulin; Glucose tolerance test; Pancreatic polypeptide; GLP-1
资金
- National Institute of Diabetes and Digestive and Kidney Diseases [R13DK083216, R13DK088452, R13DK09604]
- Abbott Laboratories
- Aptalis Pharma
- Boston Scientific
- Cook Medical
- Lilly
- Olympus through the University of Pittsburgh office of Continuing Medical Education
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. Copyright (c) 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.
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