ORLANDO – The pancreas is drawing wider interest among scientists: In one study, researchers report that already-shrunken organs keep atrophying in young people with recently diagnosed type 1 diabetes mellitus (T1DM) even as they go through adolescent growth. And another study finds that the pancreas is smaller in first-degree relatives of people with T1DM, especially relatives with pre-T1DM.
“Pancreas volume is a really exciting area of research because it may tell us something about diabetes that we just didn’t understand before,” said pediatric endocrinologist Michael J. Haller, MD, of the University of Florida, Gainesville, in an interview. Dr. Haller is coauthor of the study into pancreas volume in first-degree relatives. That study’s findings, along with the results of a Vanderbilt University/University of Texas study into pancreas volume in early T1DM, were presented at the annual meeting of the American Diabetes Association.
Scientists already know that the pancreas is 40% smaller in people who have lived with T1DM, Dr. Haller said, and “we now know that occurs long before the clinical diagnosis has been made.”
The pancreas volume mystery, he said, revolves around the fact that only 2%-3% of the organ is made up of beta cells, which make insulin. So why is there a 40% reduction in the pancreas overall? “It tells you the other parts of the pancreas are experiencing considerable damage because of the process,” he said.
In the Vanderbilt/UT study, led by Jack Virostko, PhD, at Vanderbilt University, Nashville, Tenn., researchers examined pancreas volume via MRI in patients with recent-onset T1DM (n = 51; mean age = 14 years, range 8-24 years).
The patients had a smaller median pancreas volume (29.6 mL) than similarly aged controls (49.6 mL; n = 51; P less than .001), and the gap held up after adjustment for factors like age, weight, and body mass index.
Pancreas volumes increased in controls over time as the subjects grew, but shrank even more in those with T1DM over the next year (P less than .001).
“Their research suggests there is a bit of ongoing reduction in volume,” Dr. Haller said. “That’s an area of debate in the literature, and additional larger datasets are being collected to prove or disprove that.”
For his study, Dr. Haller and University of Florida colleagues examined pancreas volume in 223 subjects (average age = 20 years; 45% males).
They found that relative pancreas volume was significantly lower vs. age-matched controls in subjects with recent-onset T1DM and in their first-degree relatives, regardless of their T1DM-related autoantibody status. First-degree relatives whose T1DM-related autoantibody status was positive – a sign of pre-T1DM – had smaller pancreas volumes than controls.
“This suggests there’s a stepwise reduction in volume that may help us understand risk better for certain patients,” Dr. Haller said.
In the future, he said, physicians may be able to use pancreas volume to distinguish between patients who otherwise appear to face the same T1DM risk. As a result, he said, they could adjust treatment accordingly.
“The datasets still need to become more robust, but it’s a really translatable kind of research,” he said, especially since it relies on MRIs “that you could use at any hospital.”