Improved glycemic control through intensive insulin therapy in pancreatic diabetes

Background: The management of pancreatic diabetes (DM) lacks consensus, as it does not fit into either the type 1 or 2 diabetes guidelines. The aim of this study was to evaluate the effectivity of intensive insulin therapy as concerns glycemic control, body weight and safety in previously orally treated patients with DM secondary to underlying chronic pancreatitis.

Methods: 13 orally treated pancreatic DM patients (10 male, 3 female, with a mean age of 57.7 (range: 47–71) years) treated with HbA1c>8% were recruited. Intensive insulin therapy was introduced instead of the oral medication, and the changes in HbA1c, fasting plasma glucose, body weight and hypoglycemic events from baseline to 2 years were measured. Results: The intensive insulin regimen reduced HbA1c by 26% (from 9.9±1.7% to 7.3±1.3%) and the fasting plasma glucose by 36% (from 14.9±5.2mmol/l to 9.5±2.8mmol/l) at 12 weeks, in both cases significantly. At week 12, 54% of the patients had a HbA1c <8%. Stable long-term control of the blood glucose and HbA1c levels was achieved; at 2 years, HbA1c had improved further: 6.9±1.2%. The body weight did not change significantly during the 2 years of therapy (73.8 vs. 72.6kg). None of the patients reported any severe hypoglycemic episode (i.e. requiring external assistance) or was hospitalized for hypoglycemia, though minor hypoglycemic attacks with good warning were documented.

Conclusions: Appropriate glycemic control without the risk of hypoglycemia can be achieved in pancreatic DM through intensive insulin therapy. Sufficient pancreatic exocrine replacement therapy is important. This work was partly supported by the TÁMOP-4.2.1./B-09/1/KONV.