Analysis of the Pancreas Functional Capacity at the Comorbidity of Chronic Pancreatitis with Diabetes Mellitus Type 2
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Abstract
The diagnosis, treatment and rehabilitation of patients with chronic pancreatitis (CP) with concomitant diabetes mellitus (DM), whose incidence is increasing.
The objective: was to investigate the state of functional capacity of the pancreas in patients with comorbidity of chronic pancreatitis and diabetes type 2.
Materials and methods. 137 patients with CP with and without concomitant diabetes mellitus were studied: the main group consisted of 112 outpatients with CP in combination with diabetes mellitus in the phase of stable or unstable remission, the comparison group – 25 patients with isolated CP, and the control group – 30 healthy individuals. Verification of diagnoses and determination of the pancreas functional capacity parameters was carried out according to generally accepted world standards.
Results. In comorbidity, exocrine insufficiency (ExI) was significantly more severe than in the group of patients with isolated CP in the content of fecal α-elastase, which corresponded to the medium and mild degrees of ExI respectively, and the coprogram score – respectively (5,60±0,10) and (3,89±0,16) points (p<0,05). We found a significant predominance of patients with comorbidity relative to that with an isolated course of CP among those who had mild (22,6 % vs. 11,7 %) and moderate (50,1 % vs. 3,7 %) degree of ExI in the complete absence of severe pancreas ExI in isolated CP against 5.1 % of such patients with CP and diabetes mellitus type 2. A statistically significant higher content of HbA1c in patients with CP with concomitant diabetes was found in relation to the group of patients with isolated CP (7,71±0,16 % vs. (5,66±0,10 %), glucose – respectively (28,89±0,33 mmol/l against 5,27±0,11 mmol/l), the level of the HOMA index – 3,29±0,07 against 1,63±0,09 (p<0,05), which confirmed the presence of IR in patients with pancreas endocrine insufficiency in the cohort of subjects, and also proved that these patients have diabetes type 2. Evaluation of the ultrasound score of the structure of the software proved that in comorbidity with diabetes mellitus, this figure is higher and corresponds to a severe degree, while in isolated CP of the studied patients – the average severity (6,25±0,67) points against (3,89±0,78) points.
Conclusion. The distribution by index and severity of patients acording M-ANNHEIM in points statistically significantly proved that the comorbidity of CP and diabetes mellitus was dominated by patients with moderate (72,2 % vs. 24,0 %) and severe CP severity (17,0 % against 8,0 %), and in isolated CP – dominated by patients with moderate severity (64,0 % vs. 4,5 %), patients with severe were more in the group of comorbid patients (6,3 % vs. 4,0 %).
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References
Horlenko O, Prylypko L, Arhij E, Moskal O, Slyvka Y. Complex visual assessment of structural changes in pancreas in the patients with chronic pancreatitis. Georgian Med News. 2019 Jul-Aug;(292-293):39–44.
Ito T, Ishiguro H, Ohara H, Kamisawa T, Sakagami J, Sata N, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol. 2016 Feb;51 (2):85–92. doi: 10.1007/s00535-015-l 149-x
Kleeff J, Whitcomb DC, Shimosegawa T, Esposito I, Lerch MM, Gress T, et al. Chronic pancreatitis. Nat Rev Dis Primers. 2017 Sep 7;3:17060. doi: 10.1038/nrdp.2017.60.
Kothari D, Ketwaroo G, Freedman SD, Sheth SG. The Impact of risk factors of chronic pancreatitis on secretin pancreatic function testing: results of a 20-year study. Pancreas. 2017 Aug;46(7):887–890. doi: 10.1097/MPA.0000000000000871.
Levy P, Dominguez-Munoz E, Imrie C, Lohr M, Maisonneuve P. Epidemiology of chronic pancreatitis: burden of the disease and consequences. United European Gastroenterol J. 2014 Oct;2(5):345–54. doi: 10.1177/2050640614548208.
Lew D, Afghani E, Pandol S. Chronic pancreatitis: current status and challenges for prevention and treatment. Dig Dis Sci. 2017 Jul;62(7):1702–1712. doi: 10.1007/s10620-017-4602-2.
Lohr JM, Oliver MR, Frulloni L. Synopsis of recent guidelines on pancreatic exocrine insufficiency. United European Gastroenterol J. 2013 Apr;l(2):79–83. doi: 10.1177/2050640613476500.
Muniraj T, Aslanian HR, Farrell J, Jamidar PA. Chronic pancreatitis, a comprehensive review and update. Part I: epidemiology, etiology, risk factors, genetics, pathophysiology, and clinical features. Dis Mon. 2014 Dec;60(12):530–50. doi: 10.1016/j.disamonth.2014.11.002.
Schneider A, Lohr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol. 2017 Feb;42(2):101–19.
Turner R. Chronic pancreatitis: Negotiating the complexities of diagnosis and management. Aust Fam Physician. 2015 Oct;44(10):718–22.
