Endocrine Abstracts

JOINT1248

Introduction: Diabetes in tropical calcific pancreatitis is a common complication with prevalence ranging from 5-10% in western population and 15-20% in southeast Asian population. Compared to type 2 diabetes, these patients need insulin earlier, have higher risk of hypoglycemia. Knowledge about risk factors would help early intervention and delay development of diabetes. In this study we have assessed the risk factors for the development of diabetes among the TCP patients.

Aim: To identify the risk factor of development of diabetes in subjects with tropical calcific pancreatitis (TCP)

Methodology: The study is a cross-sectional study conducted in a tertiary care hospital. All the patients above 18 years of age attending the Endocrinology or Gastroenterology OPD with a diagnosis of idiopathic chronic pancreatitis were included in the study. Relevant clinical history, examination and were done. Imaging details of patients were taken. For patients without diabetes OGTT was done.

Results: Total 219 patients have been enrolled whom 143 (65%) are diabetic and 76 (35%) are non-diabetic. Diabetes has a mean age of 34.7±12.7 years which is significantly higher than non- diabetics 28±10.8 years (P = 0.00). A greater number of diabetes patients had a history of surgery (15% vs 5%) and exocrine insufficiency (80.4% vs 67%) compared to non- diabetes. There is no significant difference in BMI, history of acute pancreatitis, family history of diabetes or chronic calcific pancreatitis in the two groups. Biochemical parameters showed a significantly lower C-peptide, amylase and lipase levels in diabetics compared to non-diabetics. On pancreatic imaging it is found that significantly higher number of patients with diabetes have pancreatic atrophy (95% vs 86%), parenchymal calcifications (65% vs 51%) and a larger duct size of 7 (4.2-9) vs 5 (3.8-7) mm. Multivariate logistic regression showed pancreatic parenchymal atrophy OR- 14.3 (CI-1.1-179), exocrine insufficiency (steatorrhea) OR-5.1 (CI-1.3-20), older age OR-1.05 (CI-1.0-1.1) and lower C-peptide OR- 0.05 (CI- 0.005-0.6) as risk factors for diabetes in TCP patients.

Conclusion: Among patients with TCP, those with older age, history of surgery, exocrine insufficiency and lower C-peptide levels have higher risk of diabetes mellitus. In pancreatic imaging, parenchymal calcifications, atrophy and ductal dilatation were found to be risk factors for diabetes mellitus.