title: Pancreatic polypeptide response to a mixed meal is blunted in pancreatic head cancer associated with diabetes mellitus.
abstract: BACKGROUND
  Pancreatic polypeptide (PP) is a hormone secreted by islet cells of the ventral pancreas. It has been proposed that a blunted PP response to a mixed meal can distinguish diabetes mellitus (DM) secondary to pancreatic disease from other types of DM. We performed a proof of concept study to determine if PP response to a mixed meal discriminates DM secondary to pancreatic cancer (PaCDM) from type 2 DM (T2DM).
  
  
  METHODS
  We studied 18 subjects with new onset DM (PaCDM (n = 9) and T2DM (n = 9); matched for age and gender). Serum PP levels were measured at 0, 30, and 60 min following a mixed meal. Increases in PP levels from baseline were compared using the Wilcoxon test.
  
  
  RESULTS
  In PaCDM the PP increase following a mixed meal was less than T2DM at 30 min (median 60.0%, IQR, 33.0-119.8 vs. 134.5%, IQR, 117.5-265.9; p = 0.03), but statistically similar at 60 min (median 55.8%, interquartile range (IQR) 23.7-121.5 vs. 100.0%, IQR, 47.7-202.5; p = 0.17). In PaCDM subjects, the PP increase over baseline was smaller in those with a tumor located in the pancreatic head (n = 6) compared to the body/tail (n = 3) at 30 min (41.3% vs. 158.7%, p = 0.02) and at 60 min (37.4% vs. 167.4%,p = 0.04).
  
  
  CONCLUSIONS
  Subjects with PaCDM have a blunted PP response to a mixed meal compared to T2DM. However, the blunted PP response is only observed in those PaC subjects with a tumor located in the head of the pancreas. Confirmation in larger studies may suggest this could be used to aid screening for sporadic PaC.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA; Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, OH, USA.
authors.forename: Phil A
authors.initials: PA
authors.lastname: Hart
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA.
authors.forename: Esha
authors.initials: E
authors.lastname: Baichoo
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Bi
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Hinton
authors.affiliation: Division of Endocrinology, Mayo Clinic Rochester, MN, USA.
authors.forename: Yogish C
authors.initials: YC
authors.lastname: Kudva
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA. Electronic address: chari.suresh@mayo.edu.
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D048909:Diabetes Complications / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis; D003937:Diagnosis, Differential; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D010191:Pancreatic Polypeptide / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D010191:Pancreatic Polypeptide
keywords: Pancreatic cancer; Pancreatic hormone; Pancreatic polypeptide; Pancreatogenic diabetes; Screening; Type 3c diabetes mellitus