Pancreatogenic Diabetes in Children With Recurrent Acute and Chronic Pancreatitis: Risks, Screening, and Treatment (Mini-Review)

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2022 May 13

PMID 35558377

Authors

Melena D Bellin

Affiliations

Soon will be listed here.

Abstract

Up to 9% of children with acute recurrent pancreatitis (ARP) or chronic pancreatitis have pancreatogenic diabetes mellitus (DM), and this risk likely increases as they age into adulthood. Risk factors for pancreatogenic DM in children vary depending on the clinical cohort but may include pancreatic atrophy, exocrine insufficiency, pancreatic calcifications, obesity/metabolic syndrome features, or autoimmune diseases. Knowledge regarding disease pathology is extrapolated nearly entirely from studies in adults. Insulin deficiency is the primary defect, resulting from islet loss associated with pancreatic fibrosis and cytokine-mediated β-cell dysfunction. Beta cell autoimmunity (type 1 diabetes) should also be considered as markers for this have been identified in a small subset of children with pancreatogenic DM. Hepatic insulin resistance, a deficient pancreatic polypeptide state, and dysfunctional incretin hormone response to a meal are all potential contributors in adults with pancreatogenic DM but their significance in pediatrics is yet unknown. Current guidelines recommend yearly screening for diabetes with fasting glucose and hemoglobin A1c (HbA1c). Insulin in the first-line pharmacologic therapy for treatment of pancreatogenic DM in children. Involvement of a multidisciplinary team including a pediatric endocrinologist, gastroenterologist, and dietitian are important, and nutritional health and exocrine insufficiency must also be addressed for optimal DM management.

Citing Articles

Risk Factors and Mechanisms for Diabetes in Pancreatitis.

Parra Villasmil M, Bellin M Gastroenterol Clin North Am. 2025; 54(1):175-188.

PMID: 39880526 PMC: 11780253. DOI: 10.1016/j.gtc.2024.08.002.

Clinical and imaging predictors for the development of diabetes mellitus following a single episode of acute pancreatitis in youth.

Ginzburg G, Debnath P, Zhang Y, Ata N, Farrell P, Garlapally V Dig Liver Dis. 2024; 57(2):519-525.

PMID: 39462712 PMC: 11769733. DOI: 10.1016/j.dld.2024.10.009.

Challenges of Managing Type 3c Diabetes in the Context of Pancreatic Resection, Cancer and Trauma.

Wayne C, Benbetka C, Besner G, Narayanan S J Clin Med. 2024; 13(10).

PMID: 38792534 PMC: 11122338. DOI: 10.3390/jcm13102993.

Diabetes of the Exocrine Pancreas: Implications for Pharmacological Management.

Goodarzi M, Petrov M Drugs. 2023; 83(12):1077-1090.

PMID: 37410209 PMC: 10361873. DOI: 10.1007/s40265-023-01913-5.

The Cause and Effect Relationship of Diabetes after Acute Pancreatitis.

Sliwinska-Mosson M, Bil-Lula I, Marek G Biomedicines. 2023; 11(3).

PMID: 36979645 PMC: 10044911. DOI: 10.3390/biomedicines11030667.

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