Alterations of the pancreas in type 1 diabetes - from prior to diagnosis to long-standing disease.

Abstract

Purpose: In type 1 diabetes (T1D), the loss of insulin-producing beta-cells is the hallmark pathophysiological alteration. However, volumetric and functional abnormalities of the exocrine pancreas are also observed. These changes may result from the loss of insulin's anabolic effects or reflect an underexplored aspect of T1D. Imaging techniques have enabled a better characterization of pancreatic morphology throughout T1D progression. This study examines exocrine pancreatic alterations at various stages of T1D using CT scans, including assessments conducted prior to diagnosis.

Methods: The study utilized retrospective abdominal CT scans and clinical data collected from Uppsala University Hospital, including 150 T1D subjects, with 15 examined before diagnosis, and 61 age- and gender-matched non-diabetic controls. Volume segmentation and 3D reconstruction assessed the exocrine pancreas, and pancreas volume index (PVI) calculations were standardized using body weight, BMI, and body surface area (BSA). Descriptive and laboratory data were obtained from electronic medical records.

Results: Pancreas volume was significantly reduced in T1D patients. The reduction was more pronounced in patients diagnosed before the age of 20. No significant volume difference was noted in patients before their T1D diagnosis compared to controls, however, a reduction was observed post-diagnosis. Pancreas volume correlated negatively with disease duration and HbA1c levels and correlated positively with body surface area and plasma amylase levels.

Conclusion: Pancreas volume reduction is a consistent feature in T1D, correlating with both disease duration and markers of metabolic control. These findings support the potential of using imaging techniques as a non-invasive method for monitoring T1D progression.