Characteristics of Patients with Ketosis-Prone Diabetes (KPD) Presenting with Acute Pancreatitis: Implications for the Natural History and Etiology of a KPD Subgroup.
Endocr Pract. 2013 Mar 25;:1-24
Authors: Fernandez R, Misra R, Nalini R, Hampe CS, Ozer K, Balasubramanyam A
Abstract
Objective: Reports of concomitant diabetic ketoacidosis (DKA) and acute pancreatitis (AP) are lacking among emerging forms of diabetes. This longitudinal study analyzed the characteristics of Ketosis-Prone Diabetes (KPD) presenting with concomitant AP and DKA.Methods: Multi-ethnic KPD patients (n=755) were followed prospectively from the time of index DKA with repeated metabolic and beta cell functional reserve measures for one year. Baseline and longitudinal characteristics were compared between KPD patients whose index DKA was associated with (N=54) or without (N=701) AP.Results: At baseline, the AP group had significantly higher levels of serum amylase, lipase and triglycerides, and lower bicarbonate than the Non-AP group. Patients with AP had significantly greater area under the curve for C-peptide with glucagon stimulation shortly after the index DKA, and higher fasting C-peptide (FCP) levels 6-12 months later. Using the validated "Aβ" KPD classification, 85% of AP compared to 60% of Non-AP patients (P=0.04) had β+ status (preserved beta cell functional reserve). Multivariate analysis revealed that among the subgroup of β+ KPD with an identifiable precipitating factor for the DKA ("provoked" DKA), those with AP had worse long term glycemic outcomes than those whose DKA was associated with other factors.Conclusion: Despite greater clinical severity at presentation, KPD patients with AP have better preserved beta cell function, than those without AP. β+ KPD patients presenting with AP have worse long term glycemic control than those with other causes of provoked DKA. Factors other than beta cell function negatively impact glycemic control in KPD presenting with AP.
PMID: 23529349 [PubMed - as supplied by publisher]