Juza A, Kołodziej-Spirodek L, Gutkowski K, Partyka M, Dąbrowski M. Distinguishing exocrine pancreas disease-associated diabetes from type 2 diabetes based on anthropometric and metabolic parameters. World J Diabetes 2025; 16(2): 95102 [DOI: 10.4239/wjd.v16.i2.95102]
Corresponding Author of This Article
Mariusz Dąbrowski, MD, PhD, Adjunct Associate Professor, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszów, Al. Mjr. W.Kopisto 2a, Rzeszów 35-959, Poland. mdabrowski@ur.edu.pl
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Feb 15, 2025; 16(2): 95102 Published online Feb 15, 2025. doi: 10.4239/wjd.v16.i2.95102
Distinguishing exocrine pancreas disease-associated diabetes from type 2 diabetes based on anthropometric and metabolic parameters
Anna Juza, Lilianna Kołodziej-Spirodek, Krzysztof Gutkowski, Mariusz Partyka, Mariusz Dąbrowski
Anna Juza, Krzysztof Gutkowski, Mariusz Partyka, Mariusz Dąbrowski, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszów, Rzeszów 35-959, Poland
Anna Juza, Lilianna Kołodziej-Spirodek, Diabetic Outpatient Clinic & Department of Gastroenterology and Hepatology with the Subunit of Internal Diseases, University Clinical Hospital, Rzeszów 35-055, Poland
Mariusz Partyka, Department of Internal Diseases, Nephrology and Endocrinology with the Nuclear Medicine Laboratory and the Dialysis Center & Endocrinology Outpatient Clinic, Clinical Provincial Hospital No. 2 in Rzeszów, Rzeszów 35-301, Poland
Author contributions: Gutkowski K, Partyka M, Juza A and Kołodziej-Spirodek L contributed to conceptualization and study design; Juza A and Kołodziej-Spirodek L contributed to data collection; Dąbrowski M contributed to statistical analysis and data interpretation; Juza A, Kołodziej-Spirodek L, Gutkowski K, and Partyka M contributed to data analysis; Juza A and Dąbrowski M contributed to manuscript drafting; all authors contributed to the intellectual content of the manuscript and provided approval of the final version to be published.
Institutional review board statement: The Bioethics Committee at the Regional Medical Chamber in Rzeszów, Poland provided approval for this study (Resolution No. 57/B/2015 issued on 26th June, 2015).
Informed consent statement: Each participant received information about the purpose of the study and signed an informed consent form before starting the procedures related to participation in the study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mariusz Dąbrowski, MD, PhD, Adjunct Associate Professor, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszów, Al. Mjr. W.Kopisto 2a, Rzeszów 35-959, Poland. mdabrowski@ur.edu.pl
Received: April 1, 2024 Revised: August 28, 2024 Accepted: October 29, 2024 Published online: February 15, 2025 Processing time: 272 Days and 23.4 Hours
Abstract
BACKGROUND
Adult-onset diabetes is most often considered to be type 2 diabetes. However, other types of diabetes can develop in adults, including exocrine pancreas disease-associated diabetes, also called type 3c diabetes. Differential diagnosis between these types of diabetes still remains a diagnostic challenge.
AIM
To define anthropometric and laboratory markers that will allow for early diagnosis of pancreatic disease-associated diabetes.
METHODS
The study group included 44 patients with pancreatogenic diabetes (26 with pancreatic cancer and 18 with chronic pancreatitis), while the control group consisted of 35 patients with type 2 diabetes. We analyzed several parameters, including sex, age, body mass index (BMI), fasting plasma glucose, fasting C-peptide and insulin with homeostasis model assessment of insulin resistance (HOMA-IR) index calculation, adrenomedullin, adiponectin and creatinine levels with epidermal growth factor receptor (eGFR) calculation. We also developed an equation, termed type 3c diabetes index, which utilized BMI, fasting insulin and adrenomedullin levels, and eGFR to better identify patients with type 3c diabetes.
RESULTS
Compared to patients with type 2 diabetes, patients with pancreatogenic diabetes had significantly lower BMI (25.11 ± 4.87 kg/m2vs 30.83 ± 5.21 kg/m2), fasting C-peptide (0.81 ± 0.42 nmol/L vs 1.71 ± 0.80 nmol/L), insulin (76.81 ± 63.34 pmol/L vs 233.19 ± 164.51 pmol/L) and HOMA-IR index, despite similar fasting plasma glucose levels. Patients with pancreatogenic diabetes also had lower adrenomedullin levels (0.41 ± 0.25 ng/mL vs 0.63 ± 0.38 ng/mL) but higher adiponectin levels (13.08 ± 7.20 μg/mL vs 8.28 ± 4.01 μg/mL) and eGFR levels (100.53 ± 21.60 mL/min/1.73 m2vs 85.14 ± 19.24 mL/min/1.73 m2). Finally, patients with pancreatogenic diabetes had significantly lower Type 3c diabetes index values.
CONCLUSION
Patients with pancreatogenic diabetes differ from patients with type 2 diabetes in anthropometric and laboratory parameters. The type 3c diabetes index had the highest discriminating value, above any single parameter.
Core Tip: Adult-onset diabetes is usually considered to be a type 2 diabetes mellitus. However also other types of diabetes, including diabetes in the course of exocrine pancreas diseases, are present at this age. Making an early, correct diagnosis is of utmost importance for the patient's future. Several anthropometric and laboratory parameters were found useful in differentiating these types of diabetes, and on their basis we developed an equation (type 3c diabetes index), which showed the highest sensitivity and specificity in identifying diabetes secondary to pancreatic pathology.
