Department of Endocrinology, The Mission Hospital, Durgapur, West Bengal, India.
Neottia Getwel Hospital, Siliguri, India.
Diabetes Metab Syndr. 2024 Aug;18(8):103100. doi: 10.1016/j.dsx.2024.103100. Epub 2024 Aug 8.
To study glycemic patterns and variability in patients with pancreatic diabetes or type 3c Diabetes mellitus (DM) due to chronic pancreatitis and its subtypes and assess the role of pancreatic enzyme replacement therapy (ERT) in modulating glycemic variability.
Patients having type 3c DM due to chronic pancreatitis, and on insulin underwent Flash continuous-glucose-monitoring (CGM) for 14 days. Parameters were compared between patients with fibrocalculous pancreatic diabetes (FCPD) and non-FCPD-chronic calcific pancreatitis (non-FCPD) and between the recipients and non-recipients of pancreatic enzyme-replacement-therapy (ERT).
Out of 54 patients with pancreatic diabetes, 35 patients had chronic calcific pancreatitis. They underwent CGM, median HbA1c 9.20 % (77 mmol/mol) and mean Time-In-Range (TIR) being 41.21 % (23.48). Only 5 (15.2 %) patients achieved target TIR>70 % while 16 (48.5 %) patients had high glycemic-variability [Coefficient-of-variation (CV) > 36 %]. Patients with FCPD (n = 14) had higher hypoglycemia-indices like Time-Below-Range (18.92 % vs 8.20 %; p = 0.03) and Low-Blood-Glucose-Index (18.14 % vs 6.04 %; p = 0.02) compared to non-FCPD (n = 21). HbA1c% and hyperglycemic excursions were similar in both groups. Recipients of ERT (n = 20) had lower glycemic-variability [Standard Deviation (SD) 52.15 % vs 68.14 % and CV 32.59 % vs 41.79 %, p < 0.05 for both) than non-recipients. ERT-recipients had no serious hypoglycemia within the 14 days. On subgroup analysis, lower glycemic-variability and hypoglycemia with ERT were seen only in FCPD but not in non-FCPD subgroup (50.13 vs 77.91, 30.09 vs 48.36 for SD and CV respectively, p < 0.05).
Patients with type 3c DM due to chronic pancreatitis have high frequency of hyperglycemic and hypoglycemic excursions, with those with FCPD having a particularly higher risk of hypoglycemia and glycemic-variability. Those receiving pancreatic ERT had lesser glycemic variability and hypoglycemia. The small sample size and lack of objective markers of documentation of exocrine pancreatic insufficiency like fecal elastase highlight the need for further larger studies in this field.
研究因慢性胰腺炎及其各亚型导致的胰腺性糖尿病或 3c 型糖尿病（DM）患者的血糖模式和变异性，并评估胰腺酶替代治疗（ERT）在调节血糖变异性方面的作用。
54 例因慢性胰腺炎而患有 3c 型 DM 并接受胰岛素治疗的患者进行了 14 天的 Flash 连续血糖监测（CGM）。比较纤维囊性胰腺糖尿病（FCPD）和非纤维囊性慢性钙化胰腺炎（非 FCPD）患者之间以及 ERT 接受者和非接受者之间的参数。
在 54 例胰腺性糖尿病患者中，有 35 例患有慢性钙化胰腺炎。他们接受了 CGM，中位糖化血红蛋白（HbA1c）为 9.20%（77mmol/mol），平均时间在目标范围内（TIR）为 41.21%（23.48%）。只有 5 名（15.2%）患者达到了 TIR>70%的目标，而 16 名（48.5%）患者血糖变异性较高[变异系数（CV）>36%]。FCPD（n=14）患者的低血糖指数更高，如低于目标范围的时间（18.92%比 8.20%；p=0.03）和低血糖指数（18.14%比 6.04%；p=0.02），而非 FCPD（n=21）。两组患者的 HbA1c%和高血糖发作相似。ERT 接受者（n=20）的血糖变异性较低[标准差（SD）52.15%比 68.14%和 CV 32.59%比 41.79%，均为 p<0.05]。ERT 接受者在 14 天内没有发生严重低血糖。在亚组分析中，只有 FCPD 患者接受 ERT 后血糖变异性和低血糖发生率较低（SD 分别为 50.13%和 77.91%，CV 分别为 30.09%和 48.36%，均为 p<0.05），而非 FCPD 亚组则没有（SD 分别为 70.67%和 67.17%，CV 分别为 42.21%和 43.14%）。
因慢性胰腺炎而患有 3c 型 DM 的患者高血糖和低血糖发作频率较高，FCPD 患者尤其有较高的低血糖和血糖变异性风险。接受胰腺 ERT 的患者血糖变异性和低血糖发生率较低。由于缺乏客观的外分泌胰腺功能不全的文档记录标志物，如粪便弹性蛋白酶，因此该研究的样本量较小，这突显了在该领域进行进一步更大规模研究的必要性。
