Abstract
AimsThis study harnessed the electronic medical record to assess pancreas volume in patients with type 1 diabetes (T1D) and matched controls to determine whether pancreas volume is altered in T1D and identify covariates that influence pancreas volume.MethodsThis study included 25 patients with T1D and 25 age-, sex-, and weight-matched controls from the Vanderbilt University Medical Center enterprise data warehouse. Measurements of pancreas volume were made from medical imaging studies using magnetic resonance imaging (MRI) or computed tomography (CT).ResultsPatients with T1D had a pancreas volume 47% smaller than matched controls (41.16 ml vs. 77.77 ml, P < 0.0001) as well as pancreas volume normalized by subject body weight, body mass index, or body surface area (all P < 0.0001). Pancreatic volume was smaller with a longer duration of T1D across the patient population (N = 25, P = 0.04). Additionally, four individual patients receiving multiple imaging scans displayed progressive declines in pancreas volume over time (~ 6% of volume/year), whereas five controls scanned a year apart did not exhibit a decline in pancreas size (P = 0.03). The pancreas was uniformly smaller on the right and left side of the abdomen.ConclusionsPancreas volume declines with disease duration in patients with T1D, suggesting a protracted pathological process that may include the exocrine pancreas.
Highlights
Type 1 diabetes (T1D) is preceded by a lengthy subclinical period during which the insulinproducing pancreatic beta cells are destroyed by an autoimmune process
Patients with T1D had a pancreas volume 47% smaller than matched controls (41.16 ml vs. 77.77 ml, P < 0.0001) as well as pancreas volume normalized by subject body weight, body mass index, or body surface area
Pancreas volume declines with disease duration in patients with T1D, suggesting a protracted pathological process that may include the exocrine pancreas
Summary
Type 1 diabetes (T1D) is preceded by a lengthy subclinical period during which the insulinproducing pancreatic beta cells are destroyed by an autoimmune process. Recent magnetic resonance imaging (MRI) studies have demonstrated reduced pancreatic volume (by 26–31%) within months of diagnosis [6, 7], suggesting that the size of the pancreas may be reduced prior to disease onset. Supporting this finding, organ donor studies indicate that pancreas weight is decreased in individuals without diabetes who express serum autoantibodies that portend the development of T1D [8]. These results suggest that reduced pancreas volume may be an early biomarker for type 1 diabetes and raise fundamental questions that challenge our understanding of T1D pathogenesis including whether the diabetes-prone pancreas is intrinsically abnormal and to what degree endocrine-exocrine interactions contribute to pancreatic health
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