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2 . 2022

Diabetes mellitus in patients with small-focal pancreatic necrosis

Abstract

Diabetes mellitus is recognized as a «non-infectious epidemic» of the 21st century, its prevalence is steadily increasing year by year, and the frequency of acute pancreatitis and pancreatic necrosis is similarly increasing. Hyperglycemia against the background of inflammation of the pancreas makes a significant contribution to both the tactics of patient management and its prognosis. In this connection, it is necessary to assess the state of carbohydrate metabolism in this cohort of patients.

Aim of the study – ​assessment of the state of carbohydrate metabolism in patients with newly appeared or recurrent small-focal pancreatic necrosis (involvement of less than 30% of the pancreatic parenchyma).

Material and methods. The study included 3 groups of patients. Group 1 – ​patients with the first episode of acute necrotizing pancreatitis (ANP), group 2 – ​patients with repeated ANP, group 3 – ​patients with a history of acute necrotizing pancreatitis and diagnosed diabetes mellitus. In each of the groups, a history of the presence of carbohydrate metabolism disorders, anthropometric data (body mass index, BMI) were collected from patients, the level of glucose, insulin, C-peptide and glycated hemoglobin (HbA1c) was determined.

Results. A total of 92 patients with lesions of less than 30% of the pancreatic parenchyma were included, group 1 included 53 people, group 2 – 24 people, group 3 – 15 people. Group 1 and group 2 did not significantly differ in age and BMI. In each, the number of men prevailed over the number of women by more than 2 times. The values of glucose, insulin, C-peptide and HbA1c did not differ significantly between the groups, however, a clear trend was revealed in the increase in the level of HbA1c and the decrease in the level of C-peptide from groups 1 to 3, the required level of significance was not obtained. In the group of newly emerging pancreatic necrosis (group 1), 11% of patients initially had a previously established diagnosis of diabetes mellitus. During the examination based on the determination of the level of glycated hemoglobin, diabetes mellitus was detected in total in 30% of patients of group 1. In patients with recurrent ANP, 50% already have a previously established diagnosis of diabetes mellitus, when studying the anamnesis, it was found that it was diagnosed on average one year after the first transferred ANP. The most common type of hypoglycemic therapy was the basal bolus regimen in groups 2 and 3, accounting for 54 and 67%, respectively.

Conclusion. Considering that at the first episode of pancreatic necrosis, the prevalence of diabetes mellitus is 30%, and with a relapse of ANP at the time of admission, already half of the patients have an established diagnosis of diabetes mellitus, all patients after the first pancreatic necrosis need at least an annual assessment of the state of carbohydrate metabolism with the purpose of the earliest possible diagnosis of diabetes mellitus and the timely appointment of hypoglycemic therapy. This approach will help improve the prognosis for this group of patients, minimize the risk of developing acute and late complications of diabetes mellitus.

Keywords:acute necrotizing pancreatitis; diabetes mellitus; carbohydrate metabolism; chronic pancreatitis

Funding. The study was performed within the framework of performing state assignment in the Botkin Hospital for 2021–2022, covered by budget resources of Moscow.

Conflict of interest. The authors declare no conflict of interest.

For citation: Shabunin A.V., Ametov A.S., Pashkova E.Yu., Tavobilov M.M., Karpov A.A., Bocharnikov D.S., Kolotilshchikov A.A., Golodnikov I.I., Amikishieva K.A. Diabetes mellitus in patients with small-focal pancreatic necrosis. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2022; 11 (2): 34–40. DOI: https://doi.org/10.33029/2304-9529-2022-11-2-34-40 (in Russian)

Литература/References

1. Das S.L., Singh P.P., Phillips A.R., Murphy R., Windsor J.A., Petrov M.S. Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis. // Gut. 2014. Vol. 63, N 5. P. 818–31.

2. Tu J., Zhang J., Ke L., Yang Y., Yang Q., Lu G., Li B., Tong Z., Li W., Li J. Endocrine and exocrine pancreatic insufficiency after acute pancreatitis: long-term follow-up study. // BMC Gastroenterology. 2017. Vol. 17, N 1. P. 114.

3. Tu J., Yang Y., Zhang J., Yang Q., Lu G., Li B., Tong Z., Ke L., Li W., Li J. Effect of the disease severity on the risk of developing new-onset diabetes after acute pancreatitis. // Medicine (Baltimore). 2018. Vol. 97, N 22. P. e10713.

4. Shen H.N., Yang C.C., Chang Y.H., Lu C.L., Li C.Y. Risk of Diabetes Mellitus after First-Attack Acute Pancreatitis: A National Population-Based Study. // Am J Gastroenterol. 2015. Vol. 110, N 12. P. 1698–706.

5. Vipperla K., Papachristou G.I., Slivka A., Whitcomb D.C., Yadav D. Risk of New-Onset Diabetes Is Determined by Severity of Acute Pancreatitis. // Pancreas. 2016. Vol. 45, N 1. P. e14-e15.

6. Uomo G., Gallucci F., Madrid E., Miraglia S., Manes G., Rabitti P.G. Pancreatic functional impairment following acute necrotizing pancreatitis: long-term outcome of a non-surgically treated series. // Dig Liver Dis. 2010. Vol. 42, N 2. P. 149–52.

CHIEF EDITOR
CHIEF EDITOR
Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
Вскрытие
Medicine today

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