[Insulin-dependent diabetes mellitus. Current aspects of morphology, etiology and pathogenesis]

Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review

The exocrine and endocrine pancreata are very closely linked both anatomically and physiologically. Abdominal symptoms such as nausea, bloating, diarrhea, steatorrhea, and weight loss can often occur in diabetic patients. Impairments of the exocrine pancreatic function seem to be a frequent complication of diabetes mellitus; however, they are largely overlooked. The aim of this paper is to provide an overview of the current concepts of exocrine pancreatic insufficiency (PEI) in diabetes mellitus. The prevalence and symptoms of PEI in diabetes mellitus, the pathomechanism, and difficulties of diagnosis and therapy of PEI are summarized in this systematic review.

The evaluation of serum amylase in the patients of type 2 diabetes mellitus, with a possible correlation with the pancreatic functions

BACKGROUND

Diabetes mellitus is a chronic metabolic disorder which is associated with hyperglycaemia. It is caused by a derangement in the secretion or function of the endocrinal portion of the pancreas. There is a close anatomical and functional relationship between its exocrine and endocrine portions. To address this issue, the current study was designed to evaluate the blood glucose and the amylase levels of diabetic patients as representatives of the two portions of the pancreas respectively.

AIMS AND OBJECTIVES

The aim of the present study was to determine the blood glucose, serum amylase and the serum lipid profile in known cases of type 2 Diabetes Mellitus and to compare and correlate these parameters with those of age and sex matched healthy controls.

MATERIAL AND METHODS

One hundred ten patients of type 2 Diabetes mellitus, who were already diagnosed and were taking treatment, were included in this study. 30 age and sex matched healthy individuals were recruited as the control group in our study. Fasting venous blood samples were collected from the patients as well as the controls and they were analysed by using an automated analyser for blood glucose, serum amylase and the lipid profile (serum triglycerides, total cholesterol, high density lipoproteins and low density lipoproteins). The results were analyzed statistically by using the Student's "t" test and correlation coefficients.

RESULTS

Significantly low serum amylase levels were found in the diabetic patients as compared to those in the healthy controls (p value <0.001). Also, the levels of fasting serum total cholesterol, triglycerides and the low density lipoproteins were significantly higher in the patients as compared to those in the controls, with p values of <0.05, <0.001 and <0.001 respectively. The HDL (high density lipoprotein) level was found to be lower in the diabetic patients (p value <0.001).

CONCLUSIONS

From our study, it was concluded that in type 2 Diabetes mellitus, wherever the blood glucose level was higher, the serum amylase activity was found to be significantly lower. This reflected the derangement in the endocrine-exocrine axis of the pancreas, as a disease which affected any portion of an organ would affect the adjoining area of that organ functionally. This fact must be kept in mind while the patients are treated.

Pathology of the pancreas and other organs in the diabetic LEW.1AR1/Ztm- iddm rat, a new model of spontaneous insulin-dependent diabetes mellitus

We studied the histo- and immunopathology of the endocrine and exocrine pancreas and a number of other organs in a new insulin-dependent diabetes mellitus (IDDM) rat model (LEW.1AR1/Ztm- iddm rat). The pancreas of the acutely diabetic animals showed an inflammatory infiltrate, involving all islets and ducts. The islet infiltrate was composed mainly of ED1-positive macrophages and T lymphocytes, comprising a large number of CD8(+) lymphocytes and a few CD4(+) lymphocytes. In addition, the islets displayed apoptotic cells, characterized by condensation and fragmentation of nuclear chromatin. These cells were identified as beta cells by insulin immunostaining. Other endocrine and exocrine glands, including adrenals and thyroid, as well as salivary and submandibular glands, were unaffected. Organs from the digestive tract or systemic circulatory system, including small intestine, liver, heart, and lung also showed no involvement. The kidney was intact in acutely diabetic rats. However, 6 months after diabetes manifestation, pathological changes compatible with a diabetic nephropathy had developed, affecting both the glomerula and the proximal tubular segments. It was concluded that the autoimmune process in this new IDDM rat model is restricted to the endocrine pancreas and leads to apoptotic beta cell destruction.