Secular Trends of Fibrocalculous Pancreatic Diabetes and Diabetes Secondary to Alcoholic Chronic Pancreatitis at a Tertiary Care Diabetes Centre in South India
Abstract
Context Data on prevalence and trends in diabetes secondary to chronic pancreatitis in developing countries is scarce. Objective To compare the secular trends in the prevalence of fibrocalculous pancreatic diabetes (FCPD) and diabetes secondary to alcoholic chronic pancreatitis (ACP) at a diabetes centre in south India. Research Design A retrospective analysis was done of all patients registered at Dr. Mohan’s Diabetes Specialties Centre, Chennai, India between January 1991 and December 2010. Patients A total of 1,079 subjects with diabetes secondary to chronic pancreatitis were identified, of whom 47 were excluded because of difficulty in classification. Main outcome measure The number of patients with FCPD and diabetes secondary to ACP were calculated as a percentage of the total number of diabetes patients seen at the centre during five year blocks. Results Of the total of 1,032 cases of diabetes secondary to chronic pancreatitis, FCPD comprised 898 (87%) and ACP 134 (13%). The prevalence of FCPD decreased from 1.6% during 1991-1995 to 0.2% during 2006-2010 (P<0.001). The prevalence of ACP remained constant at 0.1%. The age at diagnosis of FCPD increased (P=0.002) while that of ACP decreased (P=0.025) during the study period. There was a significant increase in BMI of FCPD P<0.001), but not of ACP (P=0.248) patients. Conclusions At this centre, FCPD continues to be more common than ACP, but there is a decline in its frequency. The age at diagnosis of FCPD has increased, while that of ACP has decreased. The decline in FCPD probably reflects improved nutrition.
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References
American Diabetes Association. Diagnosis and Classification of Diabetes. Diabetes Care 2010 Jan;33 suppl 1:S62-9.
Chen N, Unnikrishnan IR, Anjana RM, Mohan V, Pitchumoni CS. The complex exocrine-endocrine relationship and secondary diabetes in exocrine pancreatic diabetes. J Clin Gastroenterol 2011; 45: 850-61.
Gullo L Alcohol and chronic pancreatitis. Leading or secondary etiopathogenic role? Journal of Pancreas 2005; 6(1 suppl): 68-72.
Geeverghese PJ. Calcific Pancreatitis. Bombay: Verghese Publishing House,1985.
Mohan V, Premalatha G, Pitchumoni CS. Tropical chronic pancreatitis: an update. J Clin Gastroenterol 2003; 36 337-46.
WHO Study Group Report on Diabetes Mellitus. WHO technical report series 727. WHO, Geneva, 1985, 21-23.
Rajesh G, Nair AS, Narayanan VA, Balakrishnan V. Tropical pancreatitis and Fibrocalculous Pancreatic Diabetes-two sides of the same coin? Trop Gastroenterol. 2008; 29:175-6.
Mohan V, Nagalotimath SJ, Yajnik CS, Tripathy BB. Fibrocalculous pancreatic diabetes. Diab. Metab Rev 1998; 14:153-70.
Mohan V, Mohan R, Susheela L, Snehalatha C, Barani G, Mahajan VK, et al. Tropical pancreatic diabetes in South India: heterogeneity in clinical and biochemical profile. Diabetologia 1985;28:229-32.
Mohan V. Fibrocalculous pancreatic diabetes in India. Int. J. Diab. Dev. Countries. 1993;13:14-21.
Yajnik CS, Sardesai BS, Bhat DS, Naik SS et al. Ketosis resistance in fibrocalculous pancreatic diabetes. Metabolism 1997;46:1-4.
Mohan V, Snehalatha C, Ramachandran A, et al. Pancreatic beta cell function in tropical pancreatic diabetes. Metabolism 1983;32:1091-1092.
Mohan V, Snehalatha C, Ramachandran A, Chari S, Madanagopalan N, Viswanathan M. Plasma glucagon responses in tropical fibrocalculous pancreatic diabetes. Diabetes Res Clin Pract 1990;9:97-101.
Yajnik CS, Shelgikar KM, Naik SS, et al. The ketosis resistance in fibrocalculous pancreatic diabetes : clinical observations and endocrine and metabolic measurements during oral glucose tolerance test. Diabetes Res Clin Pract 1992;15:149-156.
Balaji LN, Tandon RK, Tandon BN, Banks PA. Prevalence and clinical features of chronic pancreatitis in southern India. Int J of Pancreatol. 1994 Feb;15(1):29-34.
Mohan V, Farooq S, Deepa M . Prevalence of fibrocalculous pancreatic diabetes in Chennai in South India ( CURES 61). JOP. J Pancreas (Online) 2008; 9:489-492.
Balakrishnan V, Unnikrishanan AG, Thomas V et al. Chronic pancreatitis: a prospective nationwide study of 1,086 subjects from India. JOP. J Pancreas (Online) 2008; 9: 593-600.
Pradeepa R, Prabu AV, Jebarani S, Subhashini S, Mohan V. Use of a large diabetes electronic medical record system in India: clinical and research applications. J Diabetes Sci Technol. 2011; 5: 543-52.
Mohan V, Snehalatha C, Ahmed MR, Madanagopalan N, Chari S, Jayanthi V, et al. Exocrine pancreatic function in tropical fibrocalculous pancreatic diabetes. Diabetes Care. 1989;12:145-7.
Chari ST , Mohan V, Jayanthi V , Snehalatha C, Malathi S, Viswanathan M, Madanagopalan N. Comparative study of the clinical profiles of alcoholic chronic pancreatitis and tropical chronic pancreatitis in Tamil Nadu, Southern India. Pancreas 1992;7:52-8.
Pitchumoni CS. Special problems of tropical chronic pancreatitis. Clin Gastroenterology 1984: 13: 941-59.
Mohan V, Chari ST, Viswanathan M, Madanagopalan N. Tropical chronic pancreatitis in Southern India. Proc R Coll Physicians. 1990; 20:34-42.
Mohan V, Premalatha G, Padma A, Chari ST, Pitchumoni CS. Fibrocalculous pancreatic diabetes. Long-term survival analysis. Diabetes Care 1996;19: 1274-8.
Balakrishnan V, Nair P, Radhakrishnan L, Narayanan VA. Tropical pancreatitis: a distinct entity or merely a type of chronic pancreatitis? Ind J Gastroenterol; 2006; 25:74-81.
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose or/ and impaired glucose tolerance) in rural and urban India. Phase 1 results of the Indian Council of Medical Research - India Diabetes (ICMR-INDIAB) study. Diabetologia. 2011;54:3022-3027.
Mohan V, Poongothai S, Pitchumoni CS. Oral pancreatic enzyme therapy in the control of diabetes mellitus in tropical calculous pancreatitis. Int J Pancreatology 1998;24:19-22.
Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST. Incidence, prevalence, and survivial of chronic pancreatitis: a population-based study. Am J Gastroenterol 2011; 106:2192-9.
Copyright (c) 2014 Rozario Papita, Adamsha Nazir, Viknesh Prabu Anbalagan, Ranjit Mohan Anjana, Capecomorin Pitchumoni, Suresh Chari, Viswanathan Mohan
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