FIBROCALCULOUS PANCREATIC DIABETES IN PUNE, INDIA - CLINICAL-FEATURESAND FOLLOW-UP FOR 7 YR

OBJECTIVE- To study clinical features of fibrocalculous pancreatic dia betes from this clinic, to compare these with the published criteria o f malnutrition-related diabetes mellitus, and to conduct serial follow -up of these patients to study difficulties in their treatment. RESEAR CH DESIGN AND METHODS- Details of presenting symptoms, anthropometry, diabetic tissue damage, treatment, and follow-up of 55 patients with f ibrocalculous pancreatic diabetes (pancreatic calculi demonstrated on X-ray and sonography) treated during the last 7 yr were studied. RESUL TS - Many patients did not fit the accepted criteria of malnutrition-r elated diabetes. Thus, 17 (31%) were diagnosed after 30 yr of age and 23 (42%) had a body mass index > 18 kg/m2, and the daily dose of insul in in these patients (mean 0.8 U/kg) was similar to that in the IDDM p atients (mean 1.0 U/kg). The two pathognomonic complaints (pancreatic pain and steatorrhea) were not always present. Many patients took very irregular treatment, but none suffered diabetic ketoacidosis despite stopping insulin for long periods of time; 33% of patients had some di abetic tissue damage when first seen. Fourteen patients were lost to f ollow-up, and 11 died during the follow-up. CONCLUSIONS- Clinical feat ures of these fibrocalculous pancreatic diabetes patients were somewha t different than the classic descriptions. A need exists to reconsider classification of FCPD under malnutrition-related diabetes mellitus. Many patients receive irregular treatment, and a substantial proportio n die within a few years of diagnosis, many as a result of preventable causes.