Abstract
Pancreatic diabetes is secondary diabetes followed by progressions of pancreatic exocrine diseases, such as chronic pancreatitis, pancreatic neoplasm and post-pancreatectomy. Because of destruction and reduction of the pancreatic endocrine and exocrine functional compartments, patients with pancreatic diabetes frequently show malnutrition from maldigestion and malabsorption by insufficiencies in pancreatic digestive enzymes, and show unstable glycemic control and prolonged hypoglycemia by insufficiencies in synthesis and secretion of insulin and glucagon. Epidemiological studies have suggested that the incidence and development of pancreatic diabetes in patients with chronic pancreatitis (CP) depends on several risk factors, such as alcohol intake, the presence of pancreatic calcification and the long-term duration of CP. The clinical management of pancreatic diabetes is divided into two parts: one is the supplementation of pancreatic digestive enzymes and the other is the achievement of appropriate glycemic control. The appropriate and sufficient pancreatic exocrine replacement therapy is important for the maintenance of better nutrient conditions for patients with pancreatic diabetes. Furthermore, the intensive insulin therapy combined with short- or ultra-short-acting insulin and long-acting insulin glargine can be achieved for stable glycemic control and reduction of severe frequent hypoglycemia in patients with pancreatic diabetes. These current advanced management techniques against insufficiencies of pancreatic exocrine endocrine functions are beneficial for improving and maintaining the quality of life in patients with pancreatic diabetes.
Similar content being viewed by others
References
Owyang C. Endocrine changes in pancreatic insufficiency. In: Go VLW, DiMagno EP, editors. The pancreas: biology, pathobiology and disease. New York: Raven; 1993. p. 803–13.
Koizumi M, Yoshida Y, Abe N, Shimosegawa T, Toyota T. Pancreatic diabetes in Japan. Pancreas. 1998;16:385–91.
Angelopoulos N, Dervenis C, Goula A, Rombopoulos G, Livadas S, Kaltsas D, et al. Endocrine pancreatic insufficiency in chronic pancreatitis. Pancreatology. 2005;5:122–31.
Ito T, Otsuki M, Itoi T, Shimosegawa T, Funakoshi A, Shiratori K, et al. Pancreatic diabetes in a follow-up survey of chronic pancreatitis in Japan. J Gastroenterol. 2007;42:291–7.
Kuzuya T, Iwamoto Y, Kobayashi M, Nanjo K, Sasaki A, Seino Y, et al. Report of the Committee on the classification and diagnosis criteria of diabetes mellitus. Diabetes Res Clin Pract. 2002;55:65–85.
Sjoberg RJ, Kidd GS. Pancreatic diabetes mellitus. Diabetes Care. 1989;12:715–24.
Larsen S. DM secondary to chronic pancreatitis. Dan Med Bull. 1993;40:153–62.
Miyahara T, Kawabuchi M, Goto M, Nakano I, Nada O, Nawata H. Morphological study of pancreatic endocrine in an experimental chronic pancreatitis with diabetes induced by stress and cerulein. Ultrastruct Pathol. 1999;23:171–80.
Maartense S, Ledeboer M, Masclee AA. Chronic pancreatitis: relation between function and morphology. Dig Liver Dis. 2004;36:61–7.
Goto M, Nakano I, Kimura T, Miyahara T, Kinjo M, Nawata H. New chronic pancreatitis model with diabetes induced by cerulein plus stress in rats. Dig Dis Sci. 1995;40:2356–63.
Cavallini G, Vaona B, Bovo P, Cigolini M, Rigo L, Rossi F, et al. Diabetes in chronic alcholic pancreatitis Role of residual beta cell function and insulin resistance. Dig Dis Sci. 1993;38:497–501.
Sarles H, Sarles JC, Camatte R, Muratore R, Gaini M, Guien C, et al. Observations on 205 confirmed cases of acute pancreatitis, recurring pancreatitis, and chronic pancreatitis. Gut. 1965;6:545–59.
Bank S, Marks IN, Vinik AI. Clinical and hormonal aspects of pancreatic diabetes. Am J Gastroenterol. 1975;64:13–22.
Stone VW, Sarr MG, Nagorney DM, Mcllrath DC. Chronic pancreatitis results of Whipple’s resection and total pancreatectomy. Arch Surg. 1988;123:815–9.
Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004;18:947–55.
Nakamura T, Imamura K, Takebe K, Terada A, Arai Y, Tandoh Y, et al. Correlation between pancreatic endocrine and exocrine function and characteristics of pancreatic endocrine function in patients with diabetes mellitus owing to chronic pancreatitis. Int J Pancreatol. 1996;20:169–75.
Malka D, Hammel P, Sauvanet A, Rufat P, O’Toole D, Bardet P, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology. 2000;119:1324–32.
Owens DR, Jones IR, Birtwell AJ, Burge CTR, Davies CJ, Heyburn P, et al. Study of porcine and human isophane (NPH) insulins in normal subjects. Diabetologia. 1984;26:261–5.
Peters A, Klose O, Hefty R, Keck F, Kerner W. The influence of insulin antibodies on the pharmacokinetics of NPH insulin in patients with type 1 diabetes treated with human insulin. Diabet Med. 1995;12:925–30.
Pieber TR, Eugene-Jolchine I, Derobert E. The European Study Group of HOE 901 in Type1 Diabetes. Efficacy and safety of HOE 901 versus NPH insulin in patients with type 1 diabetes. Diabetes Care. 2000;23:157–62.
Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA. The U.S. Study Group of Insulin Glargine in Type 1 Diabetes Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care. 2000;23:639–43.
Riddle MC, Rosenstock J, Gerich J. The Insulin Glargine 4002 Study Investigators Randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care. 2003;26:3080–6.
Yki-Jarvinen H, Dressler A, Ziemen M. The HOE 901/3002 Study Group Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes. Diabetes Care. 2000;23:1130–6.
Porcellati F, Rossetti P, Busciantella NR, Lucidi P, Luzio S, Owens DR, et al. Comparison of pharmacokinetics and dynamics of the long-acting insulin analogs glargine and detemir at steady state in type 1 diabetes A double-blind Randomized, crossover study. Diabetes Care. 2007;30:2447–52.
Acknowledgments
This study was supported by the Research Committee if Intractable Pancreatic Diseases, provided by the Ministry of Health, Labor, and Welfare, Japan. The authors thank S.E. Rife and H. Matsuo for their contributions to this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kawabe, K., Ito, T., Igarashi, H. et al. The current managements of pancreatic diabetes in Japan. Clin J Gastroenterol 2, 1–8 (2009). https://doi.org/10.1007/s12328-008-0052-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-008-0052-x