Is protein-deficient diabetes mellitus a pancreatitis?

Background: Malnutrition-related diabetes mellitus is a distinct clinical e ntity subdivided into protein-deficient diabetes mellitus (PDDM) and fibroc alculus pancreatic diabetes (FCPD). Whereas FCPD has obvious pancreatitis m anifested by pancreatic duct calculi, the evidence for involvement of the p ancreas in PDDM is limited to the presence of ketosis-resistant hyperglycae mia. Methods: We studied 10 patients with PDDM biochemically and radiologically. Endoscopic retrograde cholangiopancreatography was performed to determine if they had any evidence of chronic pancreatitis. Results: Their mean faecal chymotrypsin level was low (13.2 +/- 5.72 mu g/g ), as was their basal c-peptide value (0.35 +/- 0.15 mmol/L). Islet cell an tibodies were not detected in any of these patients. Ultrasound examination revealed pancreatic atrophy. In two patients, however, the pancreas was bu lky. The ERCP showed generalized thinning of the pancreatic duct, measuring 2.4 +/- 0.06 mm in the head, 2.01 +/- 0.08 mm in the body and 1.02 +/- 0.0 3 mm in tail region; side branches were seen but they were too sparse and t hin. Conclusions: The significance of these changes is not clear, but they may r epresent an ongoing pancreatic disease and may, indeed, be the earliest cha nges of chronic pancreatitis. (C) 1999 Blackwell Science Asia Pty Ltd.