Patient with diabetes mellitus in the context of chronic pancreatitis: Some features of diagnosis and treatment

The article presents a case of diagnosis and management of a patient with diabetes mellitus (DM) associated with pathology of the exocrine pancreas (DEP). The patient had a 19-year history of DEP. The cause of diabetes in this patient was a long-standing (over 25 years) chronic pancreatitis (CP). At the time of hospitalization, the patient’s C-peptide level was 0.34 ng/mL. The presence of exocrine pancreatic insufficiency was confirmed by fecal elastase-1 testing, which showed a value of 10.86 μg/g. Abdominal ultrasound (US) did not reveal specific pancreatic changes typical for CP, whereas magnetic resonance imaging detected cysts in the tail region of the pancreas. This finding highlights the low sensitivity of US for diagnosing CP, which is one of the causes of diabetes. The patient had been on long-term pancreatic enzyme replacement therapy at a dose of 10,000 units of lipase per meal and reported no complaints of exocrine insufficiency. Basal-bolus insulin therapy was used to compensate for carbohydrate metabolism disturbances. Continuous glucose monitoring with the FreeStyle Libre 2 system showed an average glucose level of 9 mmol/L, a glycemic variability of 23.6%, and no episodes of hypoglycemia were recorded. This observation emphasizes the limited utility of US in diagnosing DEP. Patients with DEP require not only hypoglycemic therapy but also enzyme replacement therapy to eliminate symptoms of exocrine pancreatic insufficiency and prevent hypoglycemia. The use of modern methods of glycemic control allows improving patients’ quality of life and enhancing the effectiveness of treatment.

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