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Long-Term Prognosis of Autoimmune Pancreatitis in Terms of Glucose Tolerance.
MedLine Citation:
PMID:  22249131     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Glucose intolerance is often observed in autoimmune pancreatitis (AIP), although its long-term prognosis after steroid treatment (ST) is still unclear. METHODS: A total of 47 patients with AIP were enrolled. On the basis of the change in hemoglobin A1c (HbA1c) and the use of diabetic medication, prognosis was classified into 3 categories, namely, "improved," "aggravated," and "unchanged." The relation between the result of an initial glucagon tolerance test (ΔCPR) and the later use of insulin during maintenance ST was examined in 20 patients. The transitions of homeostasis model assessment β cell and insulin resistance (HOMA-β and HOMA-R) were analyzed in 16 patients. RESULTS: Glucose tolerance was improved in 6 patients (13%), aggravated in 9 patients (19%), and unchanged in 32 patients (68%). All patients with ΔCPR less than 0.6 ng/mL were obliged to use insulin even after long-term observation, whereas all patients with ΔCPR more than 1.0 ng/mL were free from insulin therapy. Moreover, HOMA-β showed significant improvement after ST (43.9%→56.0% in median, P = 0.030), and HOMA-R showed significant aggravation (1.30→1.78, P = 0.039). CONCLUSIONS: Glucose tolerance that is too severely damaged may not recover fully even after ST. Thus, ST should be performed to preserve insulin secretion at the early stage of AIP.
Authors:
Kenji Hirano; Akihiro Isogawa; Minoru Tada; Hiroyuki Isayama; Naminatsu Takahara; Koji Miyabayashi; Suguru Mizuno; Dai Mohri; Kazumichi Kawakubo; Takashi Sasaki; Hirofumi Kogure; Natsuyo Yamamoto; Naoki Sasahira; Nobuo Toda; Rie Nagano; Hiroshi Yagioka; Yoko Yashima; Tsuyoshi Hamada; Yukiko Ito; Kazuhiko Koike
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-12
Journal Detail:
Title:  Pancreas     Volume:  -     ISSN:  1536-4828     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the *Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo; †Department of Internal Medicine, Mitsui Memorial Hospital; ‡Department of Gastroenterology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers; §Department of Gastroenterology, JR Tokyo General Hospital; and ∥Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan.
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