Natural history of endocrine failure in tropical chronic pancreatitis: a longitudinal follow-up study.
OBJECTIVE
Diabetes in tropical chronic pancreatitis (TCP), also known as fibrocalculous pancreatic diabetes (FCPD), is frequently seen at diagnosis. The aim of the present study was to determine the natural history of endocrine failure in TCP subjects without diabetes at baseline.


METHODS
Of 73 TCP subjects without diabetes according to World Health Organization (WHO) criteria at baseline who were seen at an out-patient center, 54 (74.0%) underwent periodic oral glucose tolerance tests on follow up. Another 54 sex-matched, non-diabetic subjects without chronic pancreatitis served as controls. Baseline demographic and clinical characteristics were noted.


RESULTS
After a median follow up of 5.0 years in TCP subjects and 7.0 years in controls, 27 of 54 TCP subjects (50%) developed diabetes compared with 14 of 54 controls (25.9%). Of the TCP subjects, those who developed diabetes on follow up were older (31 +/- 12 vs 23 +/- 11 years; P = 0.013), had a higher body mass index (21.7 +/- 4.4 vs 18.2 +/- 3.5 kg/m2; P = 0.004), higher 2 h post-load plasma glucose (8.8 +/- 1.9 vs 6.7 +/- 1.4 mmol/L; P < 0.001) and lower fecal chymotrypsin (2.1 +/- 1.2 vs 4.3 +/- 2.5 U/g; P < 0.001) at baseline compared with those who did not develop diabetes. The median time for the development of diabetes after diagnosis of TCP was 9.6 years (compared with 14.4 years among controls). Only 2 of 13 TCP subjects (15.4%) who had undergone surgical interventions during the normal glucose tolerance phase developed diabetes during follow up.


CONCLUSIONS
In TCP, there is progressive deterioration of endocrine pancreatic function, with development of diabetes in 50% of patients upon follow up, suggesting that FCPD is merely a later stage in the course of TCP. Early surgery may prevent the development of diabetes in TCP subjects.
Mohan
Viswanathan
V
Madras Diabetes Research Foundation and Dr Mohans' M. V. Diabetes Specialities Center, Gopalapuram, Chennai, India. mvdsc@vsnl.com
Barman
Karuna Kanta
KK
Rajan
Venkata Subbarao
VS
Chari
Suresh T
ST
Deepa
Raj
R
D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010195:Pancreatitis / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D014329:Tropical Climate