IDF21-0114 Comparative Study of the Clinical Profile of FCPD and T2DM patients and Assess the Link of inflammatory markers and IR

Abstract

Background: In progression of type 2 diabetes mellitus, inflammation plays an extremely vital and critical role along with insulin resistance (IR) and in long term results in further worsening of complications specially in fibrocalculous pancreatic diabetic patients (FCPD). FCPD is an uncommon form of diabetes that occurs as a result of chronic calcific pancreatitis, in the absence of alcohol abuse. Diabetes in FCPD is often brittle and difficult to control and most patients require multiple doses of insulin for control of glycemia. Aim: To assess the link between bio-inflammatory markers and IR in fibrocalculous pancreatic diabetic patients. Method: It is a cross sectional observational study. hsCRP was considered for assessing bio-inflammatory factor and HOMA index for IR among 70 FCPD subjects and 100 type 2 diabetes (T2DM). FCPD was diagnosed by evidence of ductal dilation measured by ultrasonography or by presence of pancreatic calculi on abdominal X-ray and absence of alcoholism, or other known causes of chronic pancreatitis in existing T2DM subjects. Results: 59.6±4.8 years was the mean age of the FCPD group whereas 37.4±5.1 years were for T2DM groups. FCPD patients had an earlier age at onset of diabetes (36.3 ± 15.1 years vs. 46.0±10.0 years; P = 0.031). BMI (20.7±2.1 vs 25.6±3.2 kg/m2), serum total cholesterol (147±34 vs 174±41 mg/dl), triglyceride (142±43 vs 217±94 mg/dl), and LDL cholesterol levels (91±24 vs 109±36 mg/dl) were significantly lower among FCPD patients than the T2DM patients (P<0.001). 22 subjects in FCPD group and 39 subjects in T2DM group were also diagnosed with retinopathy after initial fundoscopy. Glycated hemoglobin levels (HbA1C) were significantly higher in patients with FCPD as compare to T2DM group (9.4±2.2 vs 8.5±1.2 %, p<0.001). HOMA index among the FCPD group was 4.21 ± 1.1where as it was 5.37 ± 1.8 in T2DM group with significant P value (<0.05). A statistically significant difference (p < 0.001) was observed between the FCPD and T2DM in hsCRP (3.7±1.1 vs 1.6± 0.8). Discussion: Insulin resistance as measured by HOMA IR and inflammatory markers measured by hsCRP were found to be higher in pancreatic patients to that of type 2 DM. Despite the fact that the prevalence of FCPD being low, considering its impact of the condition on the quality of life (QOL) of the patients periodic screening is required specially for T2DM patients who complains of weight loss, back pain, abdominal pain, steatorrhoea or jaundice. Longer survival of FCPD patients also mandates periodic screening for possible risk of pancreatic adenocarcinoma.