Abstract：
BACKGROUND: Distinguishing different types of diabetes is important in directing optimized treatment strategies and correlated epidemiological studies.
OBJECTIVE: Through detailed analysis of hormone responses to mixed meal tolerance test (MMTT), we aimed to find representing characteristics of post-acute pancreatitis diabetes mellitus (PPDM-A) and post-chronic pancreatitis diabetes mellitus (PPDM-C).
METHODS: Participants with PPDM-A, PPDM-C, type 1 diabetes, type 2 diabetes, and normal controls (NCs) underwent MMTT. Fasting and postprandial responses of serum glucose, C-peptide, insulin, glucagon, pancreatic polypeptide (PP), ghrelin, gastric inhibitory peptide (GIP), glucagon like peptide-1 (GLP-1), and peptide YY (PYY) were detected and compared among different groups. Focused analysis on calculated insulin sensitivity and secretion indices were performed to determine major causes of hyperglycemia in different conditions.
RESULTS: Participants with PPDM-A were characterized by increased C-peptide, insulin, glucagon, and PP, but decreased ghrelin, GIP, and PYY compared with NCs. Patients with PPDM-C showed secretion insufficiency of C-peptide, insulin, ghrelin, and PYY, and higher postprandial responses of glucagon and PP than NCs. In particular, both fasting and postprandial levels of ghrelin in PPDM-C were significantly lower than other diabetes groups. PYY responses in patients with PPDM-A and PPDM-C were markedly reduced. Additionally, the insulin sensitivity of PPDM-A was decreased, and the insulin secretion for PPDM-C was decreased.
CONCLUSIONS: Along with the continuum from acute to chronic pancreatitis, the pathological mechanism of PPDM changes from insulin resistance to insulin deficiency. Insufficient PYY secretion is a promising diagnostic marker for distinguishing PPDM from type 1 and type 2 diabetes. Absent ghrelin secretion to MMTT may help identify PPDM-C.
OBJECTIVE: Through detailed analysis of hormone responses to mixed meal tolerance test (MMTT), we aimed to find representing characteristics of post-acute pancreatitis diabetes mellitus (PPDM-A) and post-chronic pancreatitis diabetes mellitus (PPDM-C).
METHODS: Participants with PPDM-A, PPDM-C, type 1 diabetes, type 2 diabetes, and normal controls (NCs) underwent MMTT. Fasting and postprandial responses of serum glucose, C-peptide, insulin, glucagon, pancreatic polypeptide (PP), ghrelin, gastric inhibitory peptide (GIP), glucagon like peptide-1 (GLP-1), and peptide YY (PYY) were detected and compared among different groups. Focused analysis on calculated insulin sensitivity and secretion indices were performed to determine major causes of hyperglycemia in different conditions.
RESULTS: Participants with PPDM-A were characterized by increased C-peptide, insulin, glucagon, and PP, but decreased ghrelin, GIP, and PYY compared with NCs. Patients with PPDM-C showed secretion insufficiency of C-peptide, insulin, ghrelin, and PYY, and higher postprandial responses of glucagon and PP than NCs. In particular, both fasting and postprandial levels of ghrelin in PPDM-C were significantly lower than other diabetes groups. PYY responses in patients with PPDM-A and PPDM-C were markedly reduced. Additionally, the insulin sensitivity of PPDM-A was decreased, and the insulin secretion for PPDM-C was decreased.
CONCLUSIONS: Along with the continuum from acute to chronic pancreatitis, the pathological mechanism of PPDM changes from insulin resistance to insulin deficiency. Insufficient PYY secretion is a promising diagnostic marker for distinguishing PPDM from type 1 and type 2 diabetes. Absent ghrelin secretion to MMTT may help identify PPDM-C.
摘要：
目的：区分不同类型的糖尿病对于指导优化治疗策略和相关流行病学研究非常重要。通过详细分析激素对混合餐耐量试验（MMTT）的反应，我们旨在寻找急性胰腺炎后糖尿病（PPDM-A）和慢性胰腺炎后糖尿病（PPDM-C）的代表特征。
方法：PPDM-A参与者，PPDM-C,1型糖尿病,2型糖尿病和正常对照组接受MMTT。空腹和餐后血清葡萄糖的反应，C-肽，胰岛素，胰高血糖素,胰多肽（PP），ghrelin,胃抑制肽（GIP），检测胰高血糖素样肽-1（GLP-1）和肽YY（PYY），并在不同组之间进行比较。对计算的胰岛素敏感性和分泌指数进行了重点分析，以解释不同条件下高血糖的主要原因。
结果：PPDM-A参与者的特征是C肽增加，胰岛素，胰高血糖素和PP，而减少ghrelin,GIP和PYY与对照组比较。PPDM-C患者表现为C肽分泌不足,胰岛素，ghrelin和PYY,胰高血糖素和PP的餐后反应高于对照组。特别是,PPDM-C中的空腹和餐后ghrelin水平均显著低于其他糖尿病组.PPDM-A和PPDM-C患者的PYY反应显着降低。此外,PPDM-A的胰岛素敏感性降低，PPDM-C的胰岛素分泌减少。
结论：随着从急性到慢性胰腺炎的连续性，PPDM的病理机制由胰岛素抵抗转变为胰岛素缺乏。PYY分泌不足是区分PPDM与1型和2型糖尿病的有希望的诊断标记。MMTT分泌的生长素释放肽可能有助于鉴定PPDM-C。
方法：PPDM-A参与者，PPDM-C,1型糖尿病,2型糖尿病和正常对照组接受MMTT。空腹和餐后血清葡萄糖的反应，C-肽，胰岛素，胰高血糖素,胰多肽（PP），ghrelin,胃抑制肽（GIP），检测胰高血糖素样肽-1（GLP-1）和肽YY（PYY），并在不同组之间进行比较。对计算的胰岛素敏感性和分泌指数进行了重点分析，以解释不同条件下高血糖的主要原因。
结果：PPDM-A参与者的特征是C肽增加，胰岛素，胰高血糖素和PP，而减少ghrelin,GIP和PYY与对照组比较。PPDM-C患者表现为C肽分泌不足,胰岛素，ghrelin和PYY,胰高血糖素和PP的餐后反应高于对照组。特别是,PPDM-C中的空腹和餐后ghrelin水平均显著低于其他糖尿病组.PPDM-A和PPDM-C患者的PYY反应显着降低。此外,PPDM-A的胰岛素敏感性降低，PPDM-C的胰岛素分泌减少。
结论：随着从急性到慢性胰腺炎的连续性，PPDM的病理机制由胰岛素抵抗转变为胰岛素缺乏。PYY分泌不足是区分PPDM与1型和2型糖尿病的有希望的诊断标记。MMTT分泌的生长素释放肽可能有助于鉴定PPDM-C。
