Fibrocalculous pancreatic diabetes in Bangladeshi children and adolescents—a not so rare form of secondary diabetes

Abstract

Fibrocalculous pancreatic diabetes (FCPD) is a unique form of diabetes with classic triad of abdominal pain, pancreatic calculi, and diabetes. This study was undertaken to identify the clinical characteristics in newly diagnosed children and adolescents with FCPD and compare them with children with Type 1 diabetes (T1D). The study was carried out at the Changing Diabetes in Children (CDiC) Diabetes Clinic of tertiary care hospital, BIRDEM in Bangladesh. All patients underwent abdominal X-rays and careful analysis of history of abdominal pain to differentiate the two diagnoses. Pancreatic auto antibodies were not available. Four hundred twenty-nine patients were aged under 18 years at diabetes presentation: 106 (25%) fulfilled the criteria for FCPD and 323 (75%) for T1D. When comparing FCPD with T1D at diagnosis, it was found that they were older (median age 14.0 [IQR 12.0–15.0] years vs 12.0 [IQR 10.0–14.0] years (p < .0001)). Few had a positive family history of diabetes (31% vs 48% (p = .002)). DKA was less common (4 vs 12% (p = .020)). HbA1c was higher (13.6 ± 4.2% (125 ± 22) vs 12.1 ± 3.4% (109 ± 14) (p = .001)). More FCPD patients had atypical symptoms compared to T1D (25 vs 14%, (p = .010)). The median duration of symptoms was significantly longer (3.0[1.0–6.0] vs 1.0[1.0–2.0] months (p = .0001)). Cataracts were more common in FCPD (9 vs 3% (p = .010)). The median dose of insulin was higher in FCPD patients than T1D (1.41[0.91–2.03] vs 1.02[0.78–1.48] (p = .0001)). In addition to pancreatic calcification, FCPD showed atypical symptoms with longer prodrome and higher HbA1c than T1D.