High Rate of Exocrine Pancreatic Dysfunction in Pediatric Patients with Diabetes Mellitus.

OBJECTIVE

This study aimed to describe the frequency of exocrine pancreatic disease in youth with diabetes.

METHODS

We conducted a retrospective chart review on data that was obtained from a single-center prospectively collected database of patients with diabetes. Patients were categorized as having type 1 diabetes, type 2 diabetes, or "Other" diabetes if they had cystic fibrosis-related diabetes, maturity-onset diabetes of the young, or drug/chemical-induced diabetes. All patients' charts were reviewed for exocrine pancreas disease, inclusive of pancreatitis or exocrine pancreatic insufficiency.

RESULTS

Nine hundred eighty-eight patients with a diabetes diagnosis were included. Thirty-five out of 988 (3.5%) were diagnosed with pancreatic exocrine disease. Diabetes patients with exocrine disease compared with the ones without were significantly older (13.1 y, IQR 9.8-15.3 vs. 11.7 y, P = 0.04). Those with exocrine disease were more likely to have "Other" diabetes ( P <0.0001). The exocrine group had a lower median hemoglobin A1c at diabetes diagnosis (7%, IQR 5.8%-9.2% vs. 11.3%, 8.9%-13.8%; P <0.0001). Out of the 988 patients, 18 patients had pancreatitis diagnosed, which was 2% of the overall cohort. Nine of the 18 patients were found to have developed pancreatitis after diabetes diagnosis, or 1% of the entire diabetes cohort (9/988).

CONCLUSIONS

The co-existence of exocrine and endocrine pancreatic disease occurred in 3.5% of diabetes patients. The risk of pancreatitis occurring after diabetes was 1%, a rate 100 times higher than the general pediatric population (0.01%). Future studies are needed to determine the specific mechanisms involved in the connection between endocrine and exocrine pancreatic disease in children.