Download PDF
CC BY 4.0 · Avicenna J Med 2024; 14(01): 060-068
DOI: 10.1055/s-0044-1779667
Original Article

Pancreatic Parenchymal Atrophy and Pancreatic Fat Accumulation Measured by Multidetector Computed Tomography as a Stable Marker of Chronic Progressive Type 2 Diabetes Mellitus—A Cross Sectional Observational Study

Kshipra Devadiga 
1   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Khanak K Nandolia 
1   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Mahendra Singh
3   Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Pankaj Sharma 
1   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Udit Chauhan
1   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Ravi Kant
2   Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background The most crucial step in the management of type 2 diabetes is identifying its pathogenesis and progression. Fat accumulation in the pancreas and decreased parenchymal volume can influence pancreatic function due to insulin resistance or β-cell dysfunction. This study aims to find out the difference in pancreatic volume and fat content by using contrast-enhanced computed tomography (CECT) between normal subjects and patients with different durations of type 2 diabetes mellitus (T2DM).

Methods This was a cross-sectional study. Patients who underwent CECT abdomen for the evaluation of conditions other than pancreatic origin were included. The study group was divided into three subgroups according to the duration of diabetes as <5 years, 5 to 10 years, and >10 years. In total, 40 nondiabetic controls were included. Pancreatic fat volume and parenchymal volume were measured in cm3 using CECT. Correlation between pancreatic parenchymal and fat volume with the duration of T2DM as well as with levels of hemoglobin A1c, random blood sugar, serum triglyceride, low-density lipoproteins, and high-density lipoproteins was done.

Results T2DM patients had significantly (p < 0.001) lower pancreatic parenchymal volume (mean value of 57.08 ± 8.26 cm3 in diabetics and 72.23 ± 3.41 cm3 in controls) and higher pancreatic fat volume (mean value of 3.08 ± 1.90 cm3 in diabetics and 0.67 ± 0.27cm3 in controls) as compared to nondiabetic controls. In patients with T2DM, as the duration of T2DM increased, pancreatic parenchymal volume decreased and pancreatic fat volume increased.

Conclusion Reduction in pancreatic volume and fat deposition may have a role in the onset and progression of diabetes. Determining the pancreatic volume and fat content would be useful for identifying high-risk patients and determining the pathogenesis of the development of diabetes.

Keywords

type 2 diabetes mellitus - pancreatic volume - pancreatic fat - multidetector computed tomography

Ethical Approval

This study was approved by the institutional ethics committee (Reference no-443/IEC/PGM/ 2021). This article does not contain any studies with animals performed by any of the authors. Permission from the institute medical records division was obtained to review the data of the patients.


Informed Consent

This study has obtained IRB and MRD approval. Informed consent was obtained from patients before the study.




Publication History

Article published online:
27 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008; 26 (02) 77-82
    CrossrefGoogle Scholar
  • 2 Cnop M. Fatty acids and glucolipotoxicity in the pathogenesis of Type 2 diabetes. Biochem Soc Trans 2008; 36 (Pt 3): 348-352
    CrossrefPubMedGoogle Scholar
  • 3 Karunakaran U, Park KG. A systematic review of oxidative stress and safety of antioxidants in diabetes: focus on islets and their defense. Diabetes Metab J 2013; 37 (02) 106-112
    CrossrefPubMedGoogle Scholar
  • 4 El-Assaad W, Buteau J, Peyot ML. et al. Saturated fatty acids synergize with elevated glucose to cause pancreatic beta-cell death. Endocrinology 2003; 144 (09) 4154-4163
    CrossrefPubMedGoogle Scholar
  • 5 Cnop M, Hannaert JC, Hoorens A, Eizirik DL, Pipeleers DG. Inverse relationship between cytotoxicity of free fatty acids in pancreatic islet cells and cellular triglyceride accumulation. Diabetes 2001; 50 (08) 1771-1777
    CrossrefPubMedGoogle Scholar
  • 6 Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care 2011; 34 (Suppl 2) S184-S190
    CrossrefPubMedGoogle Scholar
  • 7 Mahler RJ, Adler ML. Clinical review 102: Type 2 diabetes mellitus: update on diagnosis, pathophysiology, and treatment. J Clin Endocrinol Metab 1999; 84 (04) 1165-1171
    CrossrefPubMedGoogle Scholar
  • 8 Kaneto H, Kajimoto Y, Miyagawa J. et al. Beneficial effects of antioxidants in diabetes: possible protection of pancreatic β-cells against glucose toxicity. Diabetes 1999; 48 (12) 2398-2406
    CrossrefPubMedGoogle Scholar
  • 9 Suresh V, Reddy A, Muthukumar P. et al. Antioxidants: pharmacothearapeutic boon for diabetes. Antioxidants—Benefits, Sources, Mech Action 2021; (e-pub ahead of print). DOI: 10.5772/INTECHOPEN.98587.
    CrossrefGoogle Scholar
  • 10 Sharma R, Arora M, Gupta P, Mahajan M, Paul R, Sharma P. A retrospective study of pancreatic lipomatosis and its association with diabetes mellitus in general population in North India. Clinical Medicine and Diagnostics 2015; 5 (03) 35-38
    Google Scholar
  • 11 Fonseca V, Berger LA, Beckett AG, Dandona P. Size of pancreas in diabetes mellitus: a study based on ultrasound. Br Med J (Clin Res Ed) 1985; 291 (6504) 1240-1241
    CrossrefPubMedGoogle Scholar
  • 12 Sakata N, Egawa S, Rikiyama T. et al. Computed tomography reflected endocrine function of the pancreas. J Gastrointest Surg 2011; 15 (03) 525-532
    CrossrefPubMedGoogle Scholar
  • 13 Goda K, Sasaki E, Nagata K, Fukai M, Ohsawa N, Hahafusa T. Pancreatic volume in type 1 and type 2 diabetes mellitus. Acta Diabetol 2001; 38 (03) 145-149
    CrossrefPubMedGoogle Scholar
  • 14 Vesterhus M, Haldorsen IS, Raeder H, Molven A, Njølstad PR. Reduced pancreatic volume in hepatocyte nuclear factor 1A-maturity-onset diabetes of the young. J Clin Endocrinol Metab 2008; 93 (09) 3505-3509
    CrossrefPubMedGoogle Scholar
  • 15 Tushuizen ME, Bunck MC, Pouwels PJ. et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care 2007; 30 (11) 2916-2921
    CrossrefPubMedGoogle Scholar
  • 16 Heni M, Machann J, Staiger H. et al. Pancreatic fat is negatively associated with insulin secretion in individuals with impaired fasting glucose and/or impaired glucose tolerance: a nuclear magnetic resonance study. Diabetes Metab Res Rev 2010; 26 (03) 200-205
    CrossrefPubMedGoogle Scholar
  • 17 Saisho Y, Butler AE, Meier JJ. et al. Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin Anat 2007; 20 (08) 933-942
    CrossrefPubMedGoogle Scholar