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Incidence of endocrine and exocrine insufficiency in patients with autoimmune pancreatitis at diagnosis and after treatment: a systematic review and meta-analysis

  • Author Footnotes
    1 Marco Lanzillotta and Matteo Tacelli contributed equally.
    Marco Lanzillotta
    Correspondence
    Corresponding author at: Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
    Footnotes
    1 Marco Lanzillotta and Matteo Tacelli contributed equally.
    Affiliations
    Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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  • Author Footnotes
    1 Marco Lanzillotta and Matteo Tacelli contributed equally.
    Matteo Tacelli
    Footnotes
    1 Marco Lanzillotta and Matteo Tacelli contributed equally.
    Affiliations
    Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
    Search for articles by this author
  • Massimo Falconi
    Affiliations
    Division of Pancreatic Surgery and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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  • Paolo Giorgio Arcidiacono
    Affiliations
    Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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  • Gabriele Capurso
    Affiliations
    Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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  • Emanuel Della-Torre
    Affiliations
    Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
    Search for articles by this author
  • Author Footnotes
    1 Marco Lanzillotta and Matteo Tacelli contributed equally.
Published:March 30, 2022DOI:https://doi.org/10.1016/j.ejim.2022.03.014

      Highlights

      • DM and PEI affect one third and half of patients with AIP at diagnosis respectively.
      • DM and PEI are more frequent in type 1 AIP compared to type 2 AIP.
      • Treatment with GCs increases the risk of developing DM in AIP patients.

      Abstract

      Background

      Autoimmune pancreatitis (AIP) is a rare form of pancreatitis that may lead to endocrine and exocrine insufficiency if left untreated. AIP clinically responds to glucocorticoids (GCs) therapy, but multiple GCs courses are often required to maintain remission with detrimental effects on glycaemic control.

      Objective

      In this systematic review and meta-analysis, we aimed to assess the rate of endocrine and of exocrine insufficiency at diagnosis and at follow up in patients with AIP as well as the impact of GC therapy on pancreatic function in the long-term.

      Methods

      The MEDLINE, SCOPUS, and EMBASE databases were searched from inception to August 2021 to identify studies reporting data on endocrine and exocrine insufficiency in patients with AIP. Pooled events were calculated using a random-effect model and expressed in terms of pooled prevalence rates.

      Results

      A total of 6522 AIP patients and sixty-two studies were included in the analysis. The pooled estimate rate for the overall prevalence of diabetes in AIP at baseline was 37% (95% CI 32-42, I2 96%). The pooled prevalence rate of exocrine insufficiency was 45% (95%CI 32.9-57.4; I2 97%). The pooled estimate rate of diabetes at follow-up was 44% (95%CI 26.1-62.4) in studies where GCs were given to 100% of patients and 42% (95%CI 30.6-52.9) in studies where GCs were given to less than 100% of patients.

      Conclusion

      A large proportion of patients with AIP displays concomitant exocrine and endocrine insufficiency at the time of diagnosis. The incidence of diabetes at the longest available follow up tends to increase in patients treated with GCs.

      Keywords

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      References

        • Hart P.A.
        • Zen Y.
        • Chari ST.
        Recent Advances in Autoimmune Pancreatitis.
        Gastroenterology. 2015; 149: 39-51
        • Shimosegawa T.
        • Chari S.T.
        • Frulloni L.
        • et al.
        International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology.
        Pancreas. 2011; 40: 352-358
        • Hart P.A.
        • Kamisawa T.
        • Brugge W.R.
        • et al.
        Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut; 62.
        Epub ahead of print, 2013https://doi.org/10.1136/gutjnl-2012-303617
        • Farris A.B.
        • Lauwers G.Y.
        • Deshpande V.
        Autoimmune pancreatitis-related diabetes: Quantitative analysis of endocrine islet cells and inflammatory infiltrate.
        Virchows Arch. 2010; 457: 329-336
        • Ito T.
        • Kawabe K.
        • Arita Y.
        • et al.
        Evaluation of pancreatic endocrine and exocrine function in patients with autoimmune pancreatitis.
        Pancreas. 2007; 34: 254-259
        • Hirano K.
        • Isogawa A.
        • Tada M.
        • et al.
        Long-term prognosis of autoimmune pancreatitis in terms of glucose tolerance.
        Pancreas. 2012; 41: 691-695
        • Ito T.
        • Nakamura T.
        • Fujimori N.
        • et al.
        Characteristics of pancreatic diabetes in patients with autoimmune pancreatitis.
        J Dig Dis. 2011; 12: 210-216
        • Frulloni L.
        • Scattolini C.
        • Katsotourchi A.M.
        • et al.
        Exocrine and endocrine pancreatic function in 21 patients suffering from autoimmune pancreatitis before and after steroid treatment.
        Pancreatology. 2010; 10: 129-133
        • Vujasinovic M.
        • Valente R.
        • Maier P.
        • et al.
        Diagnosis, treatment and long-term outcome of autoimmune pancreatitis in Sweden.
        Pancreatology. 2018; 18: 900-904
        • Löhr J.M.
        • Beuers U.
        • Vujasinovic M.
        • et al.
        European Guideline on IgG4-related digestive disease – UEG and SGF evidence-based recommendations.
        United Eur Gastroenterol J. 2020; 8: 637-666
        • Kanno A.
        • Nishimori I.
        • Masamune A.
        • et al.
        Nationwide epidemiological survey of autoimmune pancreatitis in Japan.
        Pancreas. 2012; 41: 835-839
        • Nishimori I.
        • Tamakoshi A.
        • Kawa S.
        • et al.
        Influence of Steroid Therapy on the Course of Diabetes Mellitus in Patients with Autoimmune Pancreatitis Findings from a Nationwide Survey in Japan and Research Committee on Intractable Pancreatic Diseases, the Ministry of Health and Welfare of Japan.
        Pancreas. 2006; 32: 244-248
        • Miyamoto Y.
        • Kamisawa T.
        • Tabata T.
        • et al.
        Short and long-term outcomes of diabetes mellitus in patients with autoimmune pancreatitis after steroid therapy.
        Gut Liver. 2012; 6: 501-504
        • Tacelli M.
        • Celsa C.
        • Magro B.
        • et al.
        Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients With Autoimmune Pancreatitis: Systematic Review and Meta-analysis.
        Clin Gastroenterol Hepatol. 2019; 17 (e8): 1061-1072
        • Hart P.A.
        • Topazian M.D.
        • Witzig T.E.
        • et al.
        Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience. Gut; 62.
        Epub ahead of print, 2013https://doi.org/10.1136/gutjnl-2012-302886
        • Lanzillotta M.
        • Campochiaro C.
        • Mancuso G.
        • et al.
        Clinical phenotypes of IgG4-related disease reflect different prognostic outcomes.
        Rheumatol (United Kingdom). 2020; 59: 2435-2442
        • Goodarzi M.O.
        • Petrov M.S.
        • Andersen D.K.
        • et al.
        Diabetes in chronic pancreatitis: risk factors and natural history.
        Curr Opin Gastroenterol. 2021; 37: 526-531
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ; 372.
        Epub ahead of print, 2021https://doi.org/10.1136/bmj.n71
        • Schneider A.
        • Michaely H.
        • Rückert F.
        • et al.
        Diagnosing autoimmune pancreatitis with the Unifying-Autoimmune-Pancreatitis-Criteria.
        Pancreatology. 2017; 17: 381-394
        • Chari ST.
        Diagnosis of autoimmune pancreatitis using its five cardinal features: introducing the Mayo Clinic's HISORt criteria.
        J Gastroenterol. 2007; 42 (Suppl): 39-41
        • Okazaki K.
        • Kawa S.
        • Kamisawa T.
        • et al.
        Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal.
        J Gastroenterol. 2006; 41: 626-631
      1. Wells G., Shea B., O'Connell D., et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. (Available from URL http//www.ohri.ca/programs/clinical_epidemiology/oxford.asp). Epub ahead of print 2012. DOI: 10.2307/632432.

        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Contr Clin Trials. 1986; 7: 177e88
        • Higgins J.P.T.
        • Thompson SG.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Egger M.
        • Smith G.D.
        • Schneider M.
        • et al.
        Bias in meta-analysis detected by a simple, graphical test.
        Br Med J. 1997; 315: 629-634
        • Ishikawa T.
        • Kawashima H.
        • Ohno E.
        • et al.
        Clinical characteristics and long-term prognosis of autoimmune pancreatitis with renal lesions.
        Sci Rep. 2021; 11: 1-8
        • Naitoh I.
        • Kamisawa T.
        • Tanaka A.
        • et al.
        Clinical characteristics of immunoglobulin IgG4-related sclerosing cholangitis: Comparison of cases with and without autoimmune pancreatitis in a large cohort.
        Dig Liver Dis. 2021; 53: 1308-1314
        • Noguchi K.
        • Nakai Y.
        • Mizuno S.
        • et al.
        Insulin secretion improvement during steroid therapy for autoimmune pancreatitis according to the onset of diabetes mellitus.
        J Gastroenterol. 2020; 55: 198-204
        • Miki M.
        • Fujimori N.
        • Oono T.
        • et al.
        Relapse patterns and predictors of IgG4-related diseases involved with autoimmune pancreatitis: A single-center retrospective study of 115 patients.
        J Dig Dis. 2019; 20: 152-158
        • Tsang K.F.P.
        • Oppong W.K.
        • Leeds S.J.
        • et al.
        Does IgG4 level at the time of diagnosis correlate with disease outcome in IgG4-Related disease?.
        Pancreatology. 2019; 19: 177-181
        • Lee H.W.
        • Moon S.H.
        • Kim M.H.
        • et al.
        Relapse rate and predictors of relapse in a large single center cohort of type 1 autoimmune pancreatitis: long-term follow-up results after steroid therapy with short-duration maintenance treatment.
        J Gastroenterol. 2018; 53: 967-977
        • Kubota K.
        • Kamisawa T.
        • Hirano K.
        • et al.
        Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment: a Japanese multicenter study of 97 patients.
        J Hepatobiliary Pancreat Sci. 2018; 25: 223-230
        • Miyazawa M.
        • Takatori H.
        • Shimakami T.
        • et al.
        Prognosis of type 1 autoimmune pancreatitis after corticosteroid therapy-induced remission in terms of relapse and diabetes mellitus.
        PLoS One. 2017; 12: 1-11
        • Ohno Y.
        • Kumagi T.
        • Yokota T.
        • et al.
        Early pancreatic volume reduction on CT predicts relapse in patients with type 1 autoimmune pancreatitis treated with steroids.
        Orphanet J Rare Dis. 2016; 11: 1-8
        • Masamune A.
        • Nishimori I.
        • Kikuta K.
        • et al.
        Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis.
        Gut. 2017; 66: 487-494
        • Huggett M.T.
        • Culver E.
        • Kumar M.
        • et al.
        Type 1 Autoimmune Pancreatitis and IgG4-Related Sclerosing Cholangitis Is Associated With Extrapancreatic Organ Failure, Malignancy, and Mortality in a Prospective UK Cohort.
        Am J Gastroenterol. 2014; 109: 1675-1683
        • Masuda A.
        • Shiomi H.
        • Matsuda T.
        • et al.
        The relationship between pancreatic atrophy after steroid therapy and diabetes mellitus in patients with autoimmune pancreatitis.
        Pancreatology. 2014; 14: 361-365
        • Talar-Wojnarowska R.
        • Gasiorowska A.
        • Olakowski M.
        • et al.
        Utility of serum IgG, IgG4 and carbonic anhydrase II antibodies in distinguishing autoimmune pancreatitis from pancreatic cancer and chronic pancreatitis.
        Adv Med Sci. 2014; 59: 288-292
        • Miura F.
        • Sano K.
        • Amano H.
        • et al.
        Long-term surgical outcomes of patients with type 1 autoimmune pancreatitis.
        World J Surg. 2013; 37: 162-168
        • Uchida K.
        • Yazumi S.
        • Nishio A.
        • et al.
        Long-term outcome of autoimmune pancreatitis.
        J Gastroenterol. 2009; 44: 726-732
        • Park D.H.
        • Kim M.H.
        • Oh H.B.
        • et al.
        Substitution of Aspartic Acid at Position 57 of the DQβ1 Affects Relapse of Autoimmune Pancreatitis.
        Gastroenterology. 2008; 134: 440-446
        • Nishino T.
        • Toki F.
        • Oyama H.
        • et al.
        Long-term outcome of autoimmune pancreatitis after oral prednisolone therapy.
        Intern Med. 2006; 45: 497-501
        • Wakabayashi T.
        • Kawaura Y.
        • Satomura Y.
        • et al.
        Duct-narrowing chronic pancreatitis without immunoserologic abnormality: Comparison with duct-narrowing chronic pancreatitis with positive serological evidence and its clinical management.
        Dig Dis Sci. 2005; 50: 1414-1421
        • Ito T.
        • Kawa S.
        • Matsumoto A.
        • et al.
        Risk Factors for Pancreatic Stone Formation in Type 1 Autoimmune Pancreatitis: A Long-term Japanese Multicenter Analysis of 624 Patients.
        Pancreas. 2019; 48: 49-54
        • Koyama R.
        • Imamura T.
        • Okuda C.
        • et al.
        Ultrasonographic imaging of bile duct lesions in autoimmune pancreatitis.
        Pancreas. 2008; 37: 259-264
        • Tanaka S.
        • Kobayashi T.
        • Nakanishi K.
        • et al.
        Corticosteroid-responsive diabetes mellitus associated with autoimmune pancreatitis.
        Lancet. 2000; 356: 910-911
        • Ueki T.
        • Kawamoto K.
        • Otsuka Y.
        • et al.
        Prevalence and clinicopathological features of autoimmune pancreatitis in Japanese patients with inflammatory bowel disease.
        Pancreas. 2015; 44: 434-440
        • Barresi L.
        • Tacelli M.
        • Crinò S.F.
        • et al.
        Multicentric Italian survey on daily practice for autoimmune pancreatitis: Clinical data, diagnosis, treatment, and evolution toward pancreatic insufficiency.
        United Eur Gastroenterol J. 2020; 8: 705-715
        • Lee H.M.
        • Deheragoda M.
        • Harrison P.
        • et al.
        Autoimmune pancreatitis in children: A single centre experience in diagnosis, management and long term follow up.
        Pancreatology. 2019; 19: 169-176
        • Soliman H.
        • Vullierme M.P.
        • Maire F.
        • et al.
        Risk factors and treatment of relapses in autoimmune pancreatitis: Rituximab is safe and effective.
        United Eur Gastroenterol J. 2019; 7: 1073-1083
        • de Pretis N.
        • Vieceli F.
        • Brandolese A.
        • et al.
        Autoimmune pancreatitis not otherwise specified (NOS): Clinical features and outcomes of the forgotten type.
        Hepatobiliary Pancreat Dis Int. 2019; : 19-22
        • Rana S.S.
        • Gupta R.
        • Nada R.
        • et al.
        Clinical profile and treatment outcomes in autoimmune pancreatitis: A report from North India.
        Ann Gastroenterol. 2018; 31: 506-512
        • De Pretis N.
        • Amodio A.
        • Bernardoni L.
        • et al.
        Azathioprine maintenance therapy to prevent relapses in autoimmune pancreatitis.
        Clin Transl Gastroenterol. 2017; 8https://doi.org/10.1038/ctg.2017.17
        • López-Serrano A.
        • Crespo J.
        • Pascual I.
        • et al.
        Diagnosis, treatment and long-term outcomes of autoimmune pancreatitis in Spain based on the International Consensus Diagnostic Criteria: A multi-centre study.
        Pancreatology. 2016; 16: 382-390
        • Notohara K.
        • Nishimori I.
        • Mizuno N.
        • et al.
        Clinicopathological features of type 2 autoimmune pancreatitis in Japan: Results of a multicenter survey.
        Pancreas. 2015; 44: 1072-1077
        • Rasch S.
        • Phillip V.
        • Schmid R.M.
        • et al.
        Epidemiology, clinical presentation, diagnosis and treatment of autoimmune pancreatitis: A retrospective analysis of 53 patients.
        Pancreatology. 2016; 16: 73-77
        • Buijs J.
        • Cahen D.L.
        • Van Heerde M.J.
        • et al.
        The long-term impact of autoimmune pancreatitis on pancreatic function, quality of life, and life expectancy.
        Pancreas. 2015; 44: 1065-1071
        • Detlefsen S.
        • Mortensen M.B.
        • Pless T.K.
        • et al.
        Laparoscopic and percutaneous core needle biopsy plays a central role for the diagnosis of autoimmune pancreatitis in a single-center study from Denmark.
        Pancreas. 2015; 44: 845-858
        • Yurci A.
        • Stevens T.
        • Shah S.N.
        • et al.
        Evolution in the diagnosis and treatment of autoimmune pancreatitis: Experience from a single tertiary care center.
        Int J Clin Exp Pathol. 2013; 6: 1317-1326
        • Ikeura T.
        • Manfredi R.
        • Zamboni G.
        • et al.
        Application of international consensus diagnostic criteria to an Italian series of autoimmune pancreatitis.
        United Eur Gastroenterol J. 2013; 1: 276-284
        • Clark C.J.
        • Morales-Oyarvide V.
        • Zaydfudim V.
        • et al.
        Short-Term and Long-Term Outcomes for Patients with Autoimmune Pancreatitis After Pancreatectomy: A Multi-institutional Study.
        J Gastrointest Surg. 2013; 17: 899-906
        • Balasubramanian G.
        • Sugumar A.
        • Smyrk T.C.
        • et al.
        Demystifying seronegative autoimmune pancreatitis.
        Pancreatology. 2012; 12: 289-294
        • Song T.J.
        • Kim J.H.
        • Kim M.H.
        • et al.
        Comparison of clinical findings between histologically confirmed type 1 and type 2 autoimmune pancreatitis.
        J Gastroenterol Hepatol. 2012; 27: 700-708
        • Maire F.
        • Le Baleur Y.
        • Rebours V.
        • et al.
        Outcome of patients with type 1 or 2 autoimmune pancreatitis.
        Am J Gastroenterol. 2011; 106: 151-156
        • Kamisawa T.
        • Okamoto A.
        • Wakabayashi T.
        • et al.
        Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome.
        Scand J Gastroenterol. 2008; 43: 609-613
        • Church N.I.
        • Pereira S.P.
        • Deheragoda M.G.
        • et al.
        Autoimmune pancreatitis: Clinical and radiological features and objective response to steroid therapy in a UK series.
        Am J Gastroenterol. 2007; 102: 2417-2425
        • Raina A.
        • Yadav D.
        • Krasinskas A.M.
        • et al.
        Evaluation and management of autoimmune pancreatitis: experience at a large US center.
        Am J Gastroenterol. 2009; 104: 2295-2306
        • Hirano K.
        • Tada M.
        • Isayama H.
        • et al.
        Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment.
        Gut. 2007; 56: 1719-1724
        • Ryu J.K.
        • Chung J.B.
        • Park S.W.
        • et al.
        Review of 67 Patients With Autoimmune Pancreatitis in Korea.
        Pancreas. 2008; 37: 377-385
        • Kamisawa T.
        • Shimosegawa T.
        • Okazaki K.
        • et al.
        Standard steroid treatment for autoimmune pancreatitis.
        Gut. 2009; 58: 1504-1507
        • Kamisawa T.
        • Imai M.
        • Egawa N.
        • et al.
        Serum IgG4 levels and extrapancreatic lesions in autoimmune pancreatitis.
        Eur J Gastroenterol Hepatol. 2008; 20: 1167-1170
        • Xin L.
        • He Y.X.
        • Zhu X.F.
        • et al.
        Diagnosis and treatment of autoimmune pancreatitis: Experience with 100 patients.
        Hepatobiliary Pancreat Dis Int. 2014; 13: 642-648
        • Kubota K.
        • Watanabe S.
        • Uchiyama T.
        • et al.
        Factors predictive of relapse and spontaneous remission of autoimmune pancreatitis patients treated/not treated with corticosteroids.
        J Gastroenterol. 2011; 46: 834-842
        • Shimizu S.
        • Naitoh I.
        • Nakazawa T.
        • et al.
        Correlation between long-term outcome and steroid therapy in type 1 autoimmune pancreatitis: Relapse, malignancy and side effect of steroid.
        Scand J Gastroenterol. 2015; 50: 1411-1418
        • Kanai K.
        • Maruyama M.
        • Kameko F.
        • et al.
        Autoimmune Pancreatitis Can Transform into Chronic Features Similar to Advanced Chronic Pancreatitis with Functional Insufficiency Following Severe Calcification.
        Pancreas. 2016; 45: 1189-1195
        • Lee H.W.
        • Moon S.H.
        • Kim M.H.
        • et al.
        Relapse rate and predictors of relapse in a large single center cohort of type 1 autoimmune pancreatitis: long-term follow-up results after steroid therapy with short-duration maintenance treatment.
        J Gastroenterol. 2018; 53: 967-977
        • Lorenzo D.
        • Maire F.
        • Stefanescu C.
        • et al.
        Features of Autoimmune Pancreatitis Associated With Inflammatory Bowel Diseases.
        Clin Gastroenterol Hepatol. 2018; 16: 59-67
        • Yamada Y.
        • Masuda A.
        • Sofue K.
        • et al.
        Prediction of pancreatic atrophy after steroid therapy using equilibrium-phase contrast computed tomography imaging in autoimmune pancreatitis.
        JGH Open. 2020; 4: 677-683
        • Kuraishi Y.
        • Uehara T.
        • Watanabe T.
        • et al.
        Corticosteroids prevent the progression of autoimmune pancreatitis to chronic pancreatitis.
        Pancreatology. 2020; 20: 1062-1068
        • Suzuki H.
        • Ishikawa T.
        • Ohno E.
        • et al.
        An initial trial of quantitative evaluation of autoimmune pancreatitis using shear wave elastography and shear wave dispersion in transabdominal ultrasound.
        Pancreatology. 2021; 21: 682-687
        • Dozio N.
        • Indirli R.
        • Giamporcaro G.M.
        • et al.
        Impaired exocrine pancreatic function in different stages of type 1 diabetes.
        BMJ Open Diabetes Res Care. 2021; 9: 1-7
        • Mohapatra S.
        • Majumder S.
        • Smyrk T.C.
        • et al.
        Diabetes Mellitus Is Associated With an Exocrine Pancreatopathy: Conclusions From a Review of Literature.
        Pancreas. 2016; 45: 1104-1110
        • Hart P.A.
        • Andersen D.K.
        • Petrov M.S.
        • et al.
        Distinguishing diabetes secondary to pancreatic diseases from type 2 diabetes mellitus.
        Curr Opin Gastroenterol. 2021; 37: 520-525
        • Neville S.E.
        • Boye K.S.
        • Montgomery W.S.
        • et al.
        Diabetes in Japan: a review of disease burden and approaches to treatment.
        Diabetes Metab Res Rev. 2009; 25: 705-716
        • Tamayo T.
        • Rosenbauer J.
        • Wild S.H.
        • et al.
        Diabetes in Europe: An update.
        Diabetes Res Clin Pract. 2014; 103: 206-217
        • Rafacho A.
        • Ortsäter H.
        • Nadal A.
        • et al.
        Glucocorticoid treatment and endocrine pancreas function: Implications for glucose homeostasis, insulin resistance and diabetes.
        J Endocrinol. 2014; 223: R49-R62
        • Ogawa A.
        • Johnson J.H.
        • Ohneda M.
        • et al.
        Roles of insulin resistance and β-cell dysfunction in dexamethasone- induced diabetes.
        J Clin Invest. 1992; 90: 497-504
        • Kuo T.
        • McQueen A.
        • Chen T.-.C.
        • et al.
        Regulation of Glucose Homeostasis by Glucocorticoids.
        Adv Exp Med Biol. 2015; 872: 99-126
        • Lanzillotta M.
        • Vinge-Holmquist O.
        • Overbeek K.A.
        • et al.
        PrescrAIP: A Pan-European Study on Current Treatment Regimens of Auto-Immune Pancreatitis.
        Front Med. 2020; 7: 1-7