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Clinical signature and pathogenetic factors of diabetes associated with pancreas disease (T3cDM): a prospective observational study in surgical patients

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Abstract

To characterize the clinical signature and etiopathogenetic factors of diabetes associated with pancreas disease [type 3 diabetes mellitus (T3cDM)]. To estimate incidence and identify predictors of both diabetes onset and remission after pancreatic surgery. A prospective observational study was conducted. From January 2008 to December 2012, patients (n = 651) with new diagnosis of pancreatic disease admitted to the Pancreatic Surgery Unit of the San Raffaele Scientific Institute were evaluated. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up. At baseline, the prevalence of diabetes was 38 % (age of onset 64 ± 11 years). In most cases, diabetes occurred within 48 months from pancreatic disease diagnosis. Among different pancreatic diseases, minor differences were observed in diabetes characteristics, with the exception of the prevalence. Diabetes appeared associated with classical risk factors for type 2 diabetes (i.e., age, sex, family history of diabetes and body mass index), and both beta-cell dysfunction and insulin resistance appeared relevant determinants. The prevalence of adult-onset autoimmune diabetes was as previously reported within type 2 diabetes. Within a few days after surgery, either diabetes remission or new-onset diabetes was observed. In patients with pancreatic cancer, no difference in diabetes remission was observed after palliative or resective surgery. Classical risk factors for type 2 diabetes were associated with the onset of diabetes after surgery. T3cDM appeared as a heterogeneous entity strongly overlapped with type 2 diabetes.

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Abbreviations

eGFR:

Estimation of glomerular filtration rate

FPG:

Fasting plasma glucose

GADA:

Autoantibodies to glutamic acid decarboxylase

HO:

Oral hypoglycemic agents

IA-2A:

Autoantibodies to insulinoma-associated protein 2

IAA:

Autoantibodies to insulin

IFG:

Impaired fasting glucose

NFG:

Normal fasting glucose

PD:

Pancreaticoduodenectomy

PET:

Pancreatic neuroendocrine tumor

T3cDM:

Type 3 diabetes mellitus

ZnT8A:

Autoantibodies to zinc transporter 8 antigen

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Acknowledgments

This study was supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC, bando 5 × 1,000 N_12182 and Progetto IGN_11783).

Conflict of interest

Gianpaolo Balzano, Erica Dugnani, Valentina Pasquale, Giovanni Capretti, Maria Grazia Radaelli, Tania Garito, Gregorio Stratta, Alessandro Nini, Raffaele Di Fenza, Renato Castoldi, Carlo Staudacher, Michele Reni, Marina Scavini, Claudio Doglioni and Lorenzo Piemonti declare that they have no conflict of interest.

Human and Animal Rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent disclosure

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Gianpaolo Balzano, Giovanni Capretti, Gregorio Stratta, Renato Castoldi & Carlo Staudacher

  2. Diabetes Research Institute (OSR-DRI), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Erica Dugnani, Valentina Pasquale, Maria Grazia Radaelli, Tania Garito, Alessandro Nini, Raffaele Di Fenza, Marina Scavini & Lorenzo Piemonti

  3. Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Michele Reni

  4. Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Claudio Doglioni

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  1. Gianpaolo Balzano
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  3. Valentina Pasquale
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  14. Claudio Doglioni
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  15. Lorenzo Piemonti
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Corresponding author

Correspondence to Lorenzo Piemonti.

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Managed by Antonio Secchi.

Gianpaolo Balzano and Erica Dugnani have equally contributed to the manuscript.

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Balzano, G., Dugnani, E., Pasquale, V. et al. Clinical signature and pathogenetic factors of diabetes associated with pancreas disease (T3cDM): a prospective observational study in surgical patients. Acta Diabetol 51, 801–811 (2014). https://doi.org/10.1007/s00592-014-0614-y

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