A new study found that most pediatric patients with diabetes linked to pancreatitis may be unable to meet recommended blood sugar targets, despite regular testing and treatment.
Investigators reviewed medical records of 141 pediatric patients diagnosed with acute recurrent or chronic pancreatitis at a multidisciplinary clinic between 2018 and 2023. Among them, 27—or about 20%—were diagnosed with pancreatogenic diabetes, also known as type 3c diabetes.
These patients were diagnosed with diabetes at an average age of 12.9 years. Most were female (70%), Hispanic or Latino (52%), and had obesity (55%). Blood sugar control was monitored using hemoglobin A1c (HbA1c).
At their most recent visit, just 44% (n = 12/27) of them achieved an HbA1c below 7.0%, the target recommended by the American Diabetes Association. The group’s average HbA1c was 8.9%.
“Despite diverse diabetes treatments, most patients did not meet glycemic targets,” said lead study author Elizabeth Vargas, of the Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus, and colleagues.
The patients were diagnosed with diabetes at various stages: 44% prior to arriving at the clinic, 15% at their first visit, 15% during follow-up, and 26% after undergoing total pancreatectomy with islet autotransplantation (TPIAT)—a procedure in which the pancreas is removed, and islet cells are reimplanted to preserve insulin production.
The patients who underwent TPIAT were more likely to meet glycemic targets. In this group, 6 of 7 achieved an HbA1c below 7.0%, with a group average of 6.0%. In comparison, just 25% of those diagnosed prior to joining the clinic reached the same goal.
Insulin was the primary treatment for 96% of patients, with 65% using multiple daily injections and 35% using automated insulin delivery systems. Some were also treated with medications such as metformin, pioglitazone, or semaglutide. Nearly all patients received nutrition counseling.
Point-of-care HbA1c tests were routinely used during clinic visits to monitor glucose levels and guide immediate treatment decisions. Although not standard for pancreatitis-related diabetes screening, the investigators suggested that regular POC testing may have contributed to earlier detection compared with previous studies.
Islet autoantibody testing was performed to help differentiate pancreatogenic diabetes from type 1 diabetes. Slightly more than 50% of those tested were positive for at least one autoantibody.
The investigators noted that risk factors such as Hispanic and Latino ethnicity, as well as obesity, both associated with insulin resistance, may have contributed to difficulties in achieving glycemic control. The investigators called for more research into screening strategies and treatment protocols tailored to pediatric patients with pancreatitis-related diabetes.
The investigators emphasized the need for standardized guidelines and long-term follow-up to improve care in this high-risk population.
No author disclosures or competing interests were reported in the study.