Objectives: Chronic pancreatitis (CP) is associated with a high lifetime prevalence of diabetes mellitus (CPDM). However, our understanding of the pathophysiology of CP-DM in contrast to type 2 DM (T2DM) remains incomplete.
Method: We used a mixed meal tolerance test (MMTT 120 min) to assess metabolic alterations in 170 participants with CPDM or with T2DM < 3 years. The DM duration in CP was dichotomized as ≥ or < 3 years. We compared estimates of insulin sensitivity (Matsuda index), insulin secretion (insulinogenic index), and beta cell function (oral disposition index or ODI) between subgroups using Wilcoxon rank-rum tests.
Results: Area under the curve (AUC) for glucose was increased, while measures of insulin secretion were reduced in CPDM vs T2DM (Table 1). Glucagon and GIP did not differ. Insulin sensitivity was increased in CPDM <3 yrs but this cohort differs from T2DM with BMI being lower. Interestingly, CPDM ≤ 3 yrs and CPDM >3 yrs did not show any significant differences in insulinogenic index, Matsuda index and ODI.
Conclusion: The most important difference seen in both CPDM cohorts was a significant reduction in insulin secretion. Future studies are needed to understand how these differences can be used to develop personalized anti-hyperglycemic therapy for this patient population.<u></u>
Y.C. Kudva: Research Support; Dexcom, Inc. Other Relationship; Tandem Diabetes Care, Inc., Medtronic. Y. Li: Stock/Shareholder; Agenus, Inc., Mink Therapeutics, Inc. F. Wang: None. D. Yadav: Consultant; Pfizer Inc. Research Support; AbbVie Inc. D.K. Andersen: None. Z.I. Saeed: None. M. Bellin: Research Support; ViaCyte, Inc. Advisory Panel; Vertex Pharmaceuticals Incorporated, Insulet Corporation. Research Support; Dexcom, Inc. W.E. Fisher: Other Relationship; Intuitive Surgical. K. Cusi: Research Support; Echosens, Boehringer-Ingelheim, Quest Diagnostics, Inventiva Pharma, LabCorp, Nordic Bioscience A/S. Consultant; Arrowhead Pharmaceuticals, Inc., AstraZeneca, Boehringer-Ingelheim, Lilly Diabetes, 89bio, Inc., GlaxoSmithKline plc, Novo Nordisk, Siemens Healthcare Diagnostics, Sagimet Biosciences, Terns Pharmaceuticals. W. Park: Research Support; AbbVie Inc. Advisory Panel; Pfizer Inc. Consultant; Arctx Medical. Advisory Panel; Ariel Medicine. Consultant; Capsovision, Olympus. Advisory Panel; Horizon Therapeutics plc, Nestlé Health Science. S. Rizvi: None. F.G. Toledo: Advisory Panel; Sanofi. Research Support; Dompé. R.V. Considine: Research Support; Eli Lilly and Company, Adipo Therapeutics. J. Serrano: None. M.O. Goodarzi: Advisory Panel; Nestlé Health Science, Organon. P. Hart: None.
NIDDK (U01DK108327)
