Endocrine Abstracts

Introduction: Diabetes mellitus secondary to exocrine pancreas diseases (pancreatogenic DM) has an unknown incidence and is considered underdiagnosed. Our objective was to evaluate the glycemic control parameters in patients with pancreatogenic DM who started Flash glucose monitoring (FGM).

Methods: Prospective, observational study in a Spanish hospital. Patients with pancreatogenic DM who started FGM from January 2021 to August 2022 were recruited. Patient data collected included demographic, clinical, anthropometric variables, and the etiology, years of evolution, and treatment of DM. Additionally, following blood glucose control variables from the Abbott FreeStyle Libre were recorded for the first 14-days: glucose management indicator (GMI), coefficient of variation (CV), percentage of time in range (TIR) (70-180 mg/dl), in hypoglycemia (<70 mg/dl), in hyperglycemia (>180 mg/dl) and hypoglycemic events.

Results: 20 patients were included. 60% were men. Median age was 63 [IQR 57-76] years and evolution of DM was 6.5 [IQR 3.0-11.7] years. 55% were secondary to pancreatectomy (30% total, 25% partial), 25% chronic pancreatitis, 15% cystic fibrosis, and 5% hemochromatosis. Regarding of chronic complications, 15% had cardiovascular disease, and 35% microvascular complications (25% nephropathy, 15% retinopathy, 5% nephropathy). Median weight was 66.1 [IQR 61.1-71.7] kg and BMI 25.4 [IQR 22.8-27.5] kg/m2. Patients required 19.0 [IQR 14.0-27.0] IU/day of basal insulin and 6.0 [IQR 4.1-12.8] IU/day of rapid-acting insulin (total: 0.40 [IQR 0.28-0.49] IU/kg/day). In the first 14-days of FGM, a TIR of 64.0 [IQR 55.5-76.5]% (40%>70%), a time in hyperglycemia of 34.5 [IQR 21.0-44.5]% (35% <25%), and a time in hypoglycemia of 0.0% [IQR 0.0-1.7] (85% <4%, with 0% of the time in glucose < 54 mg/dl) were recorded. The CV was 32.4 [IQR 26.6-36.3]%, the GMI was 7.1% [IQR 6.9-7.7]%, and hypoglycemic events were 1.0 [IQR 0.0-3.5]. A significant higher percentage of time in hypoglycemia was obtained when comparing patients with total pancreatectomy vs other causes (1.5 [IQR 0.7-5.0]% vs 0.0 [IQR 0.0-0.2]%, P=0.026), as well as hypoglycemic events (3.5 [IQR 1.5-10.5]% vs 0.5 [IQR 0.0-2.0]%, P=0.041). However, there were no differences in TIR (63.5 [IQR 58.7-72.0]% vs 64.0 [IQR 48.5-82.2]%, P=0.968), in GMI (7.0 [IQR 6.9-7.4]% vs 7.3 [IQR 6.8-8.0]%, P=0.437) or in CV (34.8 [IQR 31.5-42.3]% vs 29.8 [IQR 26.2-35.7]%, P=0.109).

Conclusion: Despite the heterogeneous etiology of pancreatogenic DM that influences the pancreas beta cell reserve, we did not find differences in most of the glycemic control parameters. Only the time in hypoglycemia was significantly higher in patients with total pancreatectomy.