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Х1Ж) JOURNAL OF CLINICAL MEDICINE OF KAZAKHSTAN
K^ic^a хабарлама /Краткое сообщение /Short Communication DOI:10.23950/1812-2892-JCMK-00785
Association of chronic pancreatitis with risk of diabetes mellitus development
Yeldos Omirzak, Aliya Toleuova, Kairat Beibitov
Abstract
Introduction: Pancreatogenic diabetes mellitus affects the life quality and it is an independent risk factor for mortality at chronic pancreatitis. In practice, pancreatogenic diabetes mellitus is rarely diagnosed, and patients are incorrectly diagnosed with diabetes mellitus type 1 or type 2.
Objective: To determine the association of chronic pancreatitis with risk of diabetes mellitus developing.
Material and methods: Case-control study design, retrospective studies. The study was conducted on the base of the Municipal hospital №1 of Karaganda. Case histories of 23 patients, their outpatient records and discharges from hospital were studied. The patients were divided into 2 groups during the study: group 1 - the patients with chronic pancreatitis; group 2 - the patients with chronic pancreatitis and diabetes mellitus type 2.
Results and discussion: The study found that the number of patients under 60 years of age with chronic pancreatitis and diabetes mellitus are 4 times higher than the number of patients over 60 years of age. An increase in blood sugar among patients with chronic pancreatitis was associated with an exacerbation of the underlying disease. Predictors of diabetes mellitus in patients with chronic pancreatitis were female gender (OR=1,179) and high glucose level (OR=0,667). High body mass index did not affect an increase in glucose levels in patients with chronic pancreatitis. Key words: diabetes mellitus, chronic pancreatitis, glucose
СОЗЫЛМАЛЫ ПАНКРЕАТИТТЩ ЦАНТ ДИАБЕТ ЦАУ1П1МЕН БАЙЛАНЫСЫ 0Mip3aK; Е.Е., Толеуова А.С., Бейбгтов Ц.Б.
№1 1шю аурулар бeлiмшесi, Караганды медицина университету Караганды ^аласы, ^аза^стан Республикасы
Т¥ЖЫРЫМДАМА
Kipicne: ПанкреатогенФ кант диабет eMip CYpy сапасына эсер етедi жэне созылмалы панкреатит кезшдеп ел1м-жтмнщ тэуелаз факторы болып табылады. 1с ЖYзiнде, панкреатогендi кант диабет диагнозы сирек койылады, ал наукастарга дурыс емес диагноз - 1 немесе 2 типт кант диабет койылады.
Максаты: Созылмалы панкреатиттщ кант диабетн дамыту каутмен байланысын аныктау.
Материалдар мен тэстдер: Зерттеу тэсiлi - жагдай-бакылау, ретроспективтi. Зерттеу Караганды каласыныц «№1 калалык ауруханасы» негiзiнде ЖYргiзiлдi. 23 наукастыц ауру тарихтары, амбулаториялык карталар жэне ауруханадан шыгарылу кортындылары зерттелдi. Зерттеу барысында пациенттер 2 топка белЫдк 1-топ - созылмалы панкреатитпен ауыратын наукастар; 2-топ - созылмалы панкреатит жэне 2 типт кант диабет бар наукастар.
Нэтижелер мен niкiрталаc: Зерттеу барысында созылмалы панкреатит пен кант диабетмен ауыратын 60 жаска дейiнгi наукастар 60 жастан аскан адамдарга караганда 4 есе кеп екендИ аныкталды. Созылмалы панкреатитпен ауыратын наукастарда кандагы канттыц жогарылауы негiзгi аурудыц eршуiне байланысты болды. Созылмалы панкреатитпен ауыратын наукастардагы кант диабетнщ болжамдары эйелдер жынысы (OR=1,179) жэне глюкозаныц жогары децгеш (OR=0,667) болды. Сонымен катар, дене массасыныц индексi жогарылауы созылмалы панкреатитпен ауыратын наукастарда глюкоза децгешнщ жогарылауына эсер етпедi.
Heri3ri сездер: кант диабету созылмалы панкреатит, глюкоза
No1 Department of Internal Diseases, Karaganda Medical University, Karaganda city, Republic of Kazakhstan
© ®
This work is licensed under a Creative Commons Attribution 4.0 International License
Received: 2020-05-26 Accepted: 2020-06-04 UDC: 618.1
J Clin Med Kaz 2020; 4(58):73-75
Corresponding Author: Aliya Toleuova, No1 Department of Internal Diseases, Karaganda Medical University. Address: 40, Gogol Street, 100008, Karaganda city, Republic of Kazakhstan. Tel.: 87771346548 E-mail: [email protected]
СВЯЗЬ ХРОНИЧЕСКОГО ПАНКРЕАТИТА С РИСКОМ РАЗВИТИЯ САХАРНОГО ДИАБЕТА Омирзак Е.Е., Толеуова А.С., Бейбитов К.Б.
Кафедра внутренних болезней №1, Медицинский университет Караганды, город Караганда, Республика Казахстан
РЕЗЮМЕ
Введение: Панкреатогенный сахарный диабет ухудшает качество жизни и является самостоятельным фактором риска смертности при хроническом панкреатите. На практике панкреатогенный сахарный диабет диагностируют редко, а пациентам ставят неправильный диагноз - сахарный диабет первого или второго типа. Целью исследования является определение связи хронического панкреатита с риском развития сахарного диабета.
Материалы и методы: Дизайн исследования случай-контроль, ретроспективные исследования. Исследование проводилось на базе «Городской больницы №1» г. Караганды. Были изучены истории болезни, амбулаторные карты и выписки из стационаров 23 больных. В ходе исследования, больные были разделены на 2 группы: 1 группа - больные хроническим панкреатитом; 2 группа - больные хроническим панкреатитом и сахарным диабетом 2 типа.
Результаты и обсуждение: В ходе проведенного исследовния было выявлено, что больных до 60 лет, страдающих хроническим панкреатитом и сахарным диабетом в 4 раза больше, чем среди лиц старше 60 лет. Повышение уровня сахара крови среди больных хроническим панкреатитом было связано с обострением основного заболевания. Предикторами развития сахарного диабета у больных хроническим панкреатитом явились: женский пол (OR=1,179) и высокий уровень глюкозы (OR=0,667). При этом, увеличение индекса массы тела не влияло на повышение уровня глюкозы у пациентов с хроническим панкреатитом.
Ключевые слова: сахарный диабет, хронический панкреатит, глюкоза
Introduction
In the world, one person dies due to diabetes mellitus every 6 seconds. There are nearly 300 000 people with diabetes mellitus in Kazakhstan. According to different authors, the development of diabetes mellitus at chronic pancreatitis varies from 10 to 90%. Chronic pancreatitis accounts for 76% among pancreatic diseases, accompanied by diabetes development [1]. Pancreatogenic diabetes mellitus affects the life quality and it is an independent risk factor for mortality at chronic pancreatitis. In practice, pancreatogenic diabetes mellitus is rarely diagnosed, and patients are incorrectly diagnosed with diabetes mellitus type 1 or type 2 [2].
Syndrome of endocrine disorders at chronic pancreatitis manifests in 2 opposite versions: hyperinsulinism and diabetes mellitus. Hyperinsulinism occurs more often in the early stages of chronic pancreatitis and it is manifested by attacks of hypoglycemic conditions, while the level of insulin is normal or moderately elevated, the level of glucagon is within normal limits. Hypoinsulinemia and hypoglucagonemia develop with the progression of the disease, which is associated with a decrease of islet cells mass [3]. In these cases, the blood glucose level usually normalizes at the exacerbation of pancreatitis subsides. Identifying of diabetes mellitus symptoms can be difficult. In some cases, it is associated with a decrease in the need for endogenous insulin due to a reduction in the volume and calorie content of food in case of pain or strict dietary, as well as a violation of nutrient absorption against the background of exocrine pancreatic insufficiency. The degree of impaired carbohydrate metabolism in patients with chronic pancreatitis varies widely: from impaired glucose tolerance to insulin-dependent diabetes mellitus. Diabetes mellitus can also form at the beginning of clinical manifestation of chronic pancreatitis, but more often a persistent violation of carbohydrate metabolism occurs several years after the onset of the disease [3].
The objective was to determine the association of chronic pancreatitis with risk of diabetes mellitus developing.
Material and methods
Case-control study design, retrospective studies. The study was conducted on the base of the Municipal hospital №1 of Karaganda. Case histories of 23 patients, their outpatient records and discharges from hospital were studied. The patients were divided into 2 groups during the study: group 1 - the patients with chronic pancreatitis; group 2 - the patients with chronic pancreatitis and diabetes mellitus type 2. Inclusion criteria: the patients with chronic pancreatitis at the age from 38 to 80 years. Exclusion criteria: comorbid patients, patients under the
age of 38 and over 80 years old, the patients with only diabetes mellitus type 1 and type 2. The material was processed using the statistical analysis software package Statistica 8.
Results
The average age of the patients was 61.3 years (Figure 1). The gender composition included 6 (26.1%) men and 17 (73.9%) women.
Figure 1 - The age of the patients
Chronic pancreatitis+Diabetes mellitus
Chronic pancreatitis
The diagnosis of chronic pancreatitis and diabetes mellitus was established according to clinical data, biochemical parameters, and results of endoscopic ultrasound scanning. Fluctuations in glucose levels were assessed according to the patient's diaries, according to records in outpatient medical records within 30 days after discharge and written-out epicrisis from hospitals of subsequent hospitalizations. The body mass index was determined in accordance with the following formula: BMI = weight (kg) / height2 (m).
The study revealed that the number of patients under 60 years of age with chronic pancreatitis and diabetes mellitus was 4 times higher than the number of patients over 60 years of age.
Figure 2 - Fluctuations in blood sugar
I llfnilll
1 in! 1 nil ill
The results of blood sugar examination in patients with chronic pancreatitis and diabetes mellitus (Figure 2) showed the fluctuations in glucose levels ranged from 3.3 mmol/L to 23.6 mmol/L. At the same time, these fluctuations ranged from 3.1 mmol/L to 11.3 mmol/L in patients with chronic pancreatitis. An increase in blood sugar in patients with chronic pancreatitis was associated with an exacerbation of the underlying disease.
Table 1
According to the analysis of anamnestic data, it was revealed that the predictors of diabetes development in patients with chronic pancreatitis were female gender (OR=1.179) and high glucose level (OR=0.667).
The body mass index (Figure 3) in patients showed that high BMI did not affect an increase in glucose level in patients with chronic pancreatitis. Accordingly, the metabolic syndrome at chronic pancreatitis is not the cause of a decrease in glucose tolerance in this case.
Figure 3 - The body mass index in patients
Chronic pancreatitis chronic pancreatitis
+ Diabetes mellitus
■ BMI>30 ■ BMI<30
Discussion
The study found that the number of patients under 60 years of age with chronic pancreatitis and diabetes mellitus are 4 times higher than the number of patients over 60 years of age. An
Perhaps, the extension of the inflammatory process to the endocrine cells of the pancreas could cause the development of diabetes mellitus in the future.
Table 1 presents the data on the impact of the clinical data of patients with chronic pancreatitis on the risk of diabetes development.
increase in blood sugar among patients with chronic pancreatitis was associated with an exacerbation of the underlying disease. Predictors of diabetes mellitus in patients with chronic pancreatitis were female gender (OR=1,179) and high glucose level (OR=0,667). High BMI did not affect an increase in glucose levels in patients with chronic pancreatitis.
Taking into account the results of this study, it can be assumed that the inflammatory syndrome developing during exacerbation of chronic pancreatitis affects not only exocrine, but also endocrine pancreatic function. It can also be assumed that the metabolic syndrome accompanying a high body mass index and the cause of insulin resistance in diabetes mellitus type 2 is not the cause of an increase in blood sugar in chronic pancreatitis. The greater susceptibility of women to the development of chronic pancreatitis is possibly associated with pregnancy, compression of the bile ducts of the pregnant uterus.
Thus, it is necessary to more carefully approach the diagnosis and treatment of patients with chronic pancreatitis. It is necessary to study the levels of insulin and glucagon along with the study of exocrine pancreatic function. In addition, gender and age must be considered when referring to research.
Disclosures: There is no conflict of interest for all authors.
Assessment of the impact of clinical data in patients with chronic pancreatitis on the risk of diabetes development
Risk factor Odds ratio (OR) Confidence interval (95%)
Male gender 0,643 [0.106-3.913]
Female gender 1,179 [0.321-4.326]
Age 0,589 [0.183-1.900]
Glucose level 0,667 [0.128-3.470]
References
1. Tishkovskij S.V., Nikonova L.V., Doroshkevich I.P. Sovremennye podhody k lecheniju pankreatogennogo saharnogo diabeta (Modern approaches to the treatment of pancreatogenic diabetes mellitus) [in Russian]. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta. 2015; 1:14-18.
2. L.A. Rujatkina, D.S. Rujatkin. Pankreatogennyj saharnyj diabet/saharnyj diabet tipa 3S (Pancreatogenic diabetes mellitus / type 3C diabetes mellitus) [in Russian]. Saharnyj diabet. 2018; 4:28-35.
3. M. V. Lobanova. Saharnyj diabet na fone pankreatita (Diabetes mellitus on the background of pancreatitis) [in Russian]. Sluchaj izpraktiki. 2017; 3:123-130.
How to cite this article: Yeldos Omirzak, Aliya Toleuova, Kairat Beibitov. Association of chronic pancreatitis with risk of diabetes mellitus development. J Clin Med Kaz. 2020; 4(58):73-75
