Assessment of Pancreatic Sizes in Patients with Diabetes Mellitus: An Ultrasound Based Study

Iqra Ilyas*

Department of Radiological Sciences and Medical Imaging, Faculty of Health and Allied Sciences, Imperial College of Business Studies - Lahore, Pakistan

*Corresponding Author: Iqra Ilyas, Department of Radiological Sciences and Medical Imaging, Faculty of Health and Allied Sciences, Imperial College of Business Studies - Lahore, Pakistan.

Received: June 03, 2021; Published: June 15, 2021

Abstract

Aims and Objectives: To evaluate the pancreatic size in diabetic patients and compare them with regular patients.

Methodology: A prospective comparative study was conducted for six months, and 102 patients were included. Patients of type1DM, type2DM and control subjects were selected. The pancreas' ultrasound was performed on 27 healthy patients, 33 were with type 1 (Insulin-dependent diabetes mellitus), and 42 were type 2 (Non-insulin-dependent diabetes mellitus). Standard parameters of pancreatic size such as pancreatic head, pancreatic body, and pancreatic tail have been measured. The statistical analysis was performed using MedCalc.

Results: The results show that the mean age was 37 years in the control group, the mean age was 50 years in the NIDDM group, and the mean age was ten years in the IDDM group. 37% were women, and 63% were men in the control sample. Although 36.4% were females and 63.6% in the IDDM community were males. Fifty-two percent were women, and in the NIDDM, 47 percent were men.

Conclusion: Pancreatic size shows a decrease in type1DM and type2DM as compared to the control group. T1DM shows more noticeable changes compared to T2DM.

Keywords: Pancreatic Size; Insulin-dependent Diabetes Mellitus; Non-insulin Dependent Diabetes Mellitus; Ultrasound

Introduction

  In every medical assessment of the abdomen by a practitioner, measurement of pancreatic size is essential. A category of specific metabolic diseases that associate the hyperglycemia phenotype includes Diabetes mellitus (DM). Over the previous two centuries, the global incidence of diabetes has significantly increased [1]. The pancreas is one of the organs producing juices, and enzymes found hidden throughout the abdominal cavity and distributed behind the stomach. Before becoming consumed by the stomach, the pancreas' enzymes assist in metabolizing fats, proteins, and carbohydrates. Insulin, which is essential in controlling the amount of glucose in the body, is also produced by the pancreas. Multiple conditions, including diabetes mellitus, acute pancreatitis, chronic pancreatitis, and pancreatic enzyme depletion, and pancreatic tumors, can contribute to every system malfunction or abnormality that develops in the pancreas [2]. Diabetes is a form of disease correlated with an unnaturally high blood sugar glucose concentration; no insulin or inappropriate reaction to insulin secretion is made [3]. Diabetes is the most common disorder associated with the pancreas. It has the following two types: Type 1 insulin-dependent diabetes mellitus (IDDM) is also called juvenile diabetes because it affects children and adults [4]. It occurs because insulin-producing beta cells do not work or make insulin [5]. It is evaluated that approximately 80,000 children develop this form of diabetes each year [6]. Type 2 is non-insulin-dependent diabetes mellitus (NIDDM) [7]. It occurs either by reduced insulin secretions or insulin resistance. In this type, pancreatic beta cells don't respond appropriately to insulin secretions [8,9]. The pancreas is a unique organ because it has the dual function of secreting hormones into blood (endocrine) and secretes hormones through ducts (exocrine) [10]. Pancreases has a cluster of irregular-shaped endocrine cells, which are called Islet of Langerhans [11]. These islets of Langerhans contain different types of cells. In which the insulin-producing beta cells are in significant numbers [12]. Beta cells are responsible for secreting insulin when the plasma glucose level is high. The deficiency of insulin is an indicator of diabetes. Offensive production of insulin will cause blood sugar imbalance, which leads to diabetes [13]. As the insulin-producing gland, the pancreas is changed and destroyed in the process that leads to diabetes. Pancreatic markers in type I diabetic patients are infiltration of inflammatory cells in islets showing chronic inflammation and new beta cells [14]. Ultrasound is a safe, non-invasive, and cost-effective method. It has become primary tool used by doctors for the evaluation of pancreatic size. The size of the pancreas in diabetes mellitus patients has been studied. Ultrasound is expected to give better information regarding the size of the pancreas in diabetes mellitus patients [15]. A few foreign studies have indicated the improvements in pancreatic size in Type 2 Diabetes Mellitus. This research was conducted using ultrasonography to measure the pancreatic size of diabetic patients and assess if there was a correlation between the size of the pancreas and the period of diabetes to reconfirm the results of previous studies of the Pakistani diabetic population. It will be the novel research in Pakistan as such data never reported before from our part of the world.

Materials and Methods

Study design

This prospective study regarding the association of pancreatic size and the type of diabetes has been conducted.

Sample population

  The data used in this study were collected from cases visiting Allama Ehsan Hospital on Ghoray Shah Road, Near Garhi Shahu, during six months of research. A total of 27 controls, 42 patients with NIDDM, and 33 IDDM were selected for the study.

Inclusion criteria

  This study included Insulin-dependent Diabetic patients and non-insulin diabetic patients. Non-diabetic patients without any pancreatic abnormality were included in control subjects. All patients fulfilling the inclusion criteria who visited the hospital within four months following the synopsis' approval were included.

Exclusion criteria

Patients with pancreatic cancer, acute or chronic pancreatitis, and those patients who did not sign or accept the consent form were omitted.

Settings

The study was conducted in Lahore at AllamaEhsan Hospital on GhorayShah Road, Near GarhiShahu.

Equipment

Toshiba Famio 5 machine with trans-abdominal (5-7.5MHz) linear probe have been used during the study.

Examination method

  All the patients were given informed consent. The non-invasiveness was demonstrated to the patient and the importance of the procedure. It also took into account any relevant details received from the referring doctor. After this, with the patient in the supine and erect position, a trans-abdominal ultrasound was performed. Basic parameters were derived from the sizes. These included the pancreatic head, the pancreatic body, and pancreatic tail sizes.

Research methodology and statistical analysis

  This research has been conducted according to the recommended scientific methods. The relevant information has been collected from different sources, such as reference textbooks, Internet services, and scientific journals. Data were collected first on individual patient data sheets and were then tabulated in datacollection sheets. Each patient was designated as a separate ID, and names have not mentioned. No words and individual patient detail was published. All data collected during the study have been stored on a personal computer. The included subjects were grouped into three categories: IDDM, NIDDM, and control groups, and the pancreatic measurements were compared in this using T-test. The collected data has been analyzed, and results were obtained using the MEDICAL. The p-value has been obtained to evaluate statistical significance by rejecting the null hypothesis (Ho). A P-value equal to or less than 0.05 was considered as the level of value.

Results

  The analyzed results of the collected data have been presented in this section. According to data, the mean age in the control group was 37 years, the mean age in the NIDDM group was 50 years of age, and the mean age in the IDDM group was ten years of age. More details on the ages of the patients in three groups have been summarized in the following figure a.

Figure a: Shows the age statistics in various groups of the included patients.

Figure b: Shows the gender frequencies in various groups of the included patients.

  In figure b, the gender of the population has been described, and according to that, 37% were female, and 63% males in the control group. While 36.4% were females, and 63.6% were males in the IDDM group. 52% were females, and 47% were males in the NIDDM. In figure c, patients' pancreatic size has been evaluated with T-test analysis, which determines whether there was any significant difference in the pancreas parts' dimensions in various groups of the patients. Further details have been given below in figure c.

Figure c: The patients showed the following measurements of head, body, and pancreas in all three categories.

  In figure d, a significant difference in the pancreatic body in control and IDDM groups has been presented. According to the analyzed data, the sample size was 27 in the controls, and 33 were in the IDDM group. The arithmetic mean and standard deviation in sample 1 (control group) were 22.89 ± 0.9, while the sample 2 (IDDM) group was 10.20 ± 1.4. Other details have been given below in figure d.

Figure d: It shows that there is a significant difference in the pancreatic body in control and IDDM groups (P < 0.0001).

  Figure e shows a significant difference in the pancreatic body in control and NIDDM groups. According to the analyzed data, the sample size was 27 in the controls, and 42 were in the NIDDM group. The arithmetic mean and standard deviation in sample 1 (control group) was 22.89 ± 0.9, while the sample 2 (IDDM) group was 12 ± 1.9. Other details have been given below in figure e.

Figure e: It shows that there is a significant difference in the pancreatic body in control and NIDDM groups (P < 0.0001).

  Figure f shows a significant difference in the pancreatic body in IDDM and NIDDM groups. According to the analyzed data, sample size 42 was in the NIDDM group, and 33 were in IDDM. The arithmetic mean and standard deviation in NIDDM was 12 ± 1.9, while the IDDM group was 10 ± 1.4. Other details have been given below in figure f.

Figure f: It shows that there is a significant difference in the pancreatic body in IDDM and NIDDM groups (P < 0.0001).

  Figure g shows a significant difference in the pancreatic head in the control and IDDM groups. According to the analyzed data, sample size 27 was in control, and 33 was in IDDM. The arithmetic mean and standard deviation in controls was 25 ± 2.3, while the IDDM group was 11.9 ± 1.7. Other details have been given below in figure g.

Figure g: It shows that there is a significant difference in the pancreatic head in the control and IDDM groups (P < 0.0001).

  Figure h shows a significant difference in the pancreatic head in the control and NIDDM groups. According to the analyzed data, sample size 27 was in control, and 42 was in NIDDM. The arithmetic mean and standard deviation in controls was 25 ± 2.3, while the IDDM group was 18 ± 2.2. Other details have been given below in figure h.

Figure h: Shows a significant difference in the control and NIDDM groups (P < 0.0001).

  Figure i shows a significant difference in the pancreatic head in NIDDM and IDDM groups. According to the analyzed data, sample size 42 was in NIDDM, and 33 was in IDDM. The arithmetic mean and standard deviation in NIDDM was 18 ± 2.2, while the IDDM group was 11.9 ± 1.7. Other details have been given below in figure i.

Figure i: It shows that there is a significant difference in the pancreatic head in NIDDM and IDDM groups (P < 0.0001).

  In figure j, a significant difference in the pancreatic tail in control and IDDM groups has been presented. According to the analyzed data, sample size 27 was in control, and 33 was in IDDM. The arithmetic mean and standard deviation in control was 15.4 ± 2.0, while the IDDM group was 8.4 ± 1.5. Other details have been given below in figure j.

Figure j: It shows that there is a significant difference in the pancreatic tail in control and IDDM groups (P < 0.0001).

  Figure k shows a significant difference in the pancreatic tail in control and NIDDM groups. According to the analyzed data, sample size 27 was in control, and 42 was in NIDDM. The arithmetic mean and standard deviation in control was 15.4 ± 2.0, while the NIDDM group was 9.5 ± 1.1. Other details have been given below in figure k.

Figure k: It shows that there is a significant difference in the pancreatic tail in control and NIDDM groups (P < 0.0001).

  Figure l shows a significant difference in the pancreatic tail in NIDDM and IDDM groups. According to the analyzed data, sample size 42 was in NIDDM, and 33 was in IDDM. The arithmetic mean and standard deviation in NIDDM was 9.5 ± 1.1, while the IDDM group was 8.4 ± 1.5. Other details have been given below in figure l.

Figure l: Shows a significant difference in the pancreatic tail in NIDDM and IDDM groups (P < 0.0001).

Figure 1 compares the distribution of pancreatic body sizes in three groups, e.g., control, IDDM, and NIDDM. Variations have been shown in the NIDDM and IDDM.

Figure 1: Graphical explanation shows the comparison of the distribution of pancreatic body sizes in three groups.

Figure 2 compares the distribution of pancreatic head size in three groups, e.g., control, IDDM, and NIDDM. Variations have been shown in the NIDDM and IDDM than in the control group.

Figure 2: Graphical explanation shows the comparison of the distribution of pancreatic head sizes in three groups.

Figure 3 compares the distribution of pancreatic tail size in three groups, e.g., control, IDDM, and NIDDM. Variations have been shown in the NIDDM and IDDM than in the control group.

Figure 3: Graphical explanation shows the comparison of the distribution of pancreatic tail sizes in three groups.

Figure 4: Image showing ultrasonography abnormalities (a) Pancreatic Head (b) Pancreatic Body (c) Pancreatic Tail in NIDDM patients.

  The pancreases of NIDDM patients differed from those of control subjects only in terms of a greater pancreatic body diameter. NIDDM patients were generally obese and may have been hyper-insulinemic.

Figure 5: Image Showing Ultrasonography Abnormalities Pancreatic Head, Body, and Tail in IDDM patients.

The decrease of pancreatic diameters of patients with IDDM was time-dependent, clearly evident of disease, and probably related to acinar atrophy and fibrosis.

Discussion

  In clinical imaging, the modality of ultrasound is beneficial in the detection of diabetes. From post-mortem histological assessment, it has already been known that the pancreatic sizes in patients with IDDM are much smaller than those in ordinary people. To confirm this observation in insulin-dependent diabetes and determine whether the pancreatic size is also altered in non-insulin-dependent diabetes mellitus, we studied the pancreatic size in patients with diabetes mellitus using ultrasound techniques. The pancreatic sizes in patients with diabetes type 1 and 2 were evaluated and compared with those in control subjects using sonography. The pancreas with T2DM and T1DM showed atrophy of the pancreas by showing reduced sizes compared to normal control subjects.

  Interestingly, it has been found that pancreatic sizes of IDDM were significantly less than those in NIDDM. Multiple previous studies [15-21] showed that the smaller' sizes were significantly lower in patients with type IDDM than in type II or NIDDM. Similarly, both of these patients showed substantially lower pancreatic than in the standard group. The results of our study are in complete agreement with the results of these mentioned studies. Foulis., et al. demonstrated that in type I diabetic patients, 23 percent of island cells are affected by insulitis (inflammatory cell infiltration). The condition was responsible for the immune-mediated destruction, leading to a significant decrease in the pancreas' size and weight [22]. NIDDM has been reported to be resulting from a combination of two pathological processes, insulin resistance and markedly decreased response of insulin to the changes in glucose blood levels. The latter has been attributed at least partly to the lethal effects of even mild chronic hyperglycemia and associated high levels of plasma non-esterifies fatty acids on pancreatic beta cells. This process is sometimes termed as “gluco-lipotoxicity” [23]. Our study was the first such study on the topic done in this part of the world. The results of the survey validated those reported from other countries.

Conclusion

  It has been concluded that the pancreas shows a decreased size in patients with both types of diabetes mellitus. The decrement in size is more prominent in insulin-dependent/insulin-deficient subjects. A more detailed study with a higher number of included issues is required.

Acknowledgments

  I want to thank the Department of Radiological Sciences and Medical Imaging, Faculty of Health and Allied Sciences, Imperial College of Business Studies - Lahore, Pakistan, for the unlimited support in conducting research, especially to the Head of Department.

Financial Support and Sponsorship

No Funding Source.

Conflicts of Interest

No.

Data collection sheet

Figure:

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Citation

Citation: Iqra Ilyas. “Assessment of Pancreatic Sizes in Patients with Diabetes Mellitus: An Ultrasound Based Study”.Acta Scientific Medical Sciences 5.7 (2021): 44-52.

Copyright

Copyright: © 2021 Iqra Ilyas. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.