EXOCRINE PANCREATIC DUCTOGRAMS IN INSULIN-DEPENDENT DIABETES-MELLITUS

Objectives: To examine the prevalence of abnormal pancreatic ductogram s in patients with insulin-dependent diabetes mellitus (IDDM) and to d etermine the clinical characteristics of those patients. Methods: Panc reatic exocrine morphology was studied by endoscopic retrograde pancre atography (ERP) in 43 patients with IDDM, 12 patients with islet cell antibody (ICA)-positive non-insulin-dependent diabetes mellitus (NIDDM ), and 22 patients with ICA-negative NIDDM. Results: ERP revealed a si gnificantly higher prevalence of abnormal pancreatic ducts (dilation a nd stenosis, tortuosity, obstruction, and intraductal calculi) in the patients with IDDM (17/43, 40%) than in the patients with ICA-negative NIDDM (2/22, 9%, p = 0.018). IDDM patients who slowly progressed to i nsulin dependency more than 13 months after the onset of diabetes had a higher frequency of abnormal pancreatic ducts (13/22, 59%) than thos e who needed insulin therapy within 12 months after the onset (4/21, 1 9%, p = 0.016). There was no difference in duration of diabetes betwee n the two groups. ICA-positive NIDDM patients also had a higher freque ncy of abnormal pancreatic ducts (7/12, 58%) than ICA-negative NIDDM p atients (2/22, 9%, p = 0.0074). Conclusions: These results indicate th at a high proportion of IDDM patients who have prolonged histories of non-insulin dependency with ICA suffer pancreatic exocrine impairment. A similarity between IDDM with a slowly progressive clinical course a nd fibrocalculous pancreatic diabetes seen in tropical countries also was suggested.