title: Relationship between pancreatic hormones and glucose metabolism: A cross-sectional study in patients after acute pancreatitis.
abstract: Abnormal glucose metabolism is present in almost 40% of patients after acute pancreatitis, but its pathophysiology has been poorly investigated. Pancreatic hormone derangements have been sparingly studied to date, and their relationship with abnormal glucose metabolism is largely unknown. The aim was to investigate the associations between pancreatic hormones and glucose metabolism after acute pancreatitis, including the effect of potential confounders. This was a cross-sectional study of 83 adult patients after acute pancreatitis. Fasting venous blood was collected from all patients and used for analysis of insulin, glucagon, pancreatic polypeptide, amylin, somatostatin, C-peptide, glucose, and hemoglobin A1c. Statistical analyses were conducted using the modified Poisson regression, multivariable linear regression, and Spearman's correlation. Age, sex, body mass index, recurrence of acute pancreatitis, duration from first attack, severity, and etiology were adjusted for. Increased insulin was significantly associated with abnormal glucose metabolism after acute pancreatitis, in both unadjusted (P = 0.038) and adjusted (P = 0.001) analyses. Patients with abnormal glucose metabolism also had significantly decreased pancreatic polypeptide (P = 0.001) and increased amylin (P = 0.047) in adjusted analyses. Somatostatin, C-peptide, and glucagon were not changed significantly in both unadjusted and adjusted analyses. Increased insulin resistance and reduced insulin clearance may be important components of hyperinsulinemic compensation in patients after acute pancreatitis. Increased amylin and reduced pancreatic polypeptide fasting levels characterize impaired glucose homeostasis. Clinical studies investigating islet-cell hormonal responses to mixed-nutrient meal testing and euglycemic-hyperinsulinemic clamps are now warranted for further insights into the role of pancreatic hormones in glucose metabolism derangements secondary to pancreatic diseases.
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand;
authors.forename: Sayali A
authors.initials: SA
authors.lastname: Pendharkar
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand;
authors.forename: Varsha M
authors.initials: VM
authors.lastname: Asrani
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand;
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Xiao
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand;
authors.forename: Harry D
authors.initials: HD
authors.lastname: Yoon
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Rinki
authors.initials: R
authors.lastname: Murphy
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand;
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand; max.petrov@gmail.com.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005215:Fasting / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000209:etiology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D058228:Islet Amyloid Polypeptide / Q000097:blood; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010187:Pancreatic Hormones / Q000097:blood*; D010191:Pancreatic Polypeptide / Q000097:blood; D010195:Pancreatitis / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000201:enzymology*; D013004:Somatostatin / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005934:Glucagon; D006442:Glycated Hemoglobin; D007328:Insulin; D058228:Islet Amyloid Polypeptide; D010187:Pancreatic Hormones; D010191:Pancreatic Polypeptide; D013004:Somatostatin; C517652:hemoglobin A1c protein, human
keywords: acute pancreatitis; amylin; glucose metabolism; insulin; pancreatic polypeptide