Diabetes due to exocrine pancreatic disease-a review of patients attending a hospital-based diabetes clinic

Abstract

Background: Diabetes secondary to underlying exocrine pancreatic disease is a specific, but heterogeneous, type of diabetes mellitus. Studies such as UKPDS and DCTT excluded patients with pancreatic diabetes, so there is a paucity of evidence regarding best clinical practice in this group.Aim: To characterize the clinical features of patients with diabetes secondary to underlying pancreatic disease attending general diabetes clinics in a single hospital.Design and Methods: A cross-sectional observational cohort study, identifying patients with pancreatic diabetes from clinic letters and medical notes at the University Hospital of Wales, Cardiff, UK.Results: The notes of 38 patients with pancreatic diabetes were reviewed. Of these, six had pancreatic malignancy and the remainder had a range of benign disorders. The majority (29/38) had diabetes diagnosed at or shortly after the pancreatic diagnosis was made. There was a lack of consistency regarding initial hypoglycaemic therapy, with metformin alone being the most common initial therapy, but with 30/38 taking insulin within 12 months of diagnosis. Similarly, a broad range of insulin regimens were employed with twice daily pre-mixed insulin being most prevalent. Sixty-three percent of patients were prescribed lipid lowering therapy and 42% were taking anti-hypertensives. Glycaemic control, as estimated by the latest HbA1C, was no different in patients with pancreatic diabetes compared to the general clinic population and there were no reports of severe hypoglycaemia.Conclusions: There is great variability in how patients with pancreatic diabetes are currently managed. Future clinical trials should specifically address this group. © The Author 2010. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.