EXOCRINE PANCREATIC AND BETA-CELL FUNCTION IN MALNUTRITION-RELATED DIABETES AMONG NORTH INDIANS

OBJECTIVE - To compare the pancreatic exocrine and beta-cell function in the two variants of malnutrition-related diabetes mellitus (MRDM): fibrocalculous pancreatic diabetes (FCPD) and protein-deficient pancre atic diabetes (PDPD). RESEARCH DESIGN AND METHODS - Fecal chymotrypsin (FCT) and fasting C-peptide levels were measured in 20 consecutive pa tients with FCPD and 19 with PDPD. FCPD was diagnosed by pancreatic ca lcification on ultrasonography, while the diagnosis of PDPD was made o n the basis of low body mass index, severe diabetes requiring insulin therapy, and ketosis resistance on interruption of insulin. Twenty pat ients with type I diabetes and 32 healthy subjects served as control s ubjects. RESULTS - Both FCPD and PDPD patients had diminished levels o f FCT when compared with those of control subjects and patients with t ype I diabetes. However, FCT levels were significantly lower in subjec ts with FCPD (median 0.4 U/g, range 0-8.9 U/g), in comparison with tho se with PDPD (4.7 U/g, 0.6-40.5 U/g; P < 0.001). Of the FCPD patients, 13 of 20 (65%) had severe exocrine pancreatic deficiency (FCT <1 U/g) vs. 3 of 19 (15.8%) PDPD subjects (P < 0.01). In comparison with cont rol subjects, fasting serum C-peptide levels were significantly dimini shed in both MRDM groups. However, C-peptide levels in subjects with F CPD (mean +/- SE, 0.22 +/- 0.04 nmol/l) and PDPD (0.26 +/- 0.04 nmol/l ) were comparable. CONCLUSIONS - Among the two variants of MRDM, subje cts with FCPD have severe pancreatic exocrine deficiency in comparison with those with PDPD, even though their C-peptide levels are comparab ly diminished. This suggests that the pathogenesis of these two entiti es may differ or that the genetic and/or environmental factors leading to exocrine damage are different.