Pancreatic polypeptide in patients with type 1 diabetes and exocrine failure or chronic pancreatitis. The DIAPP study - 09/11/25

Doi : 10.1016/j.diabet.2025.101712

Lea Dehghani ¹, Fideline Bonnet-Serrano ^2,³, Hendy Abdul ⁴, Laure Alexandre-Heymann ^1,³, Jean Guibourdenche ², Etienne Larger ^1,^3,^⁎
¹ Service de diabétologie et immunologie Clinique, Hôpital Cochin, APHP. Centre-Université Paris Cité, Paris, France
² UF d’hormonologie, Hôpital Cochin, APHP. Centre-Université Paris Cité, Paris, France
³ Université Paris Cité, Paris, France and INSERM U1016, Institut Cochin, Paris, France
⁴ Unité de recherche clinique, Hôpital Cochin, APHP. Centre-Université Paris Cité, Paris, France

^⁎Corresponding author.

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Abstract

Introduction

. - Exocrine dysfunction can occur in type 1 diabetes (T1D). When exocrine function is impaired, it is unclear whether alterations also involve other endocrine cell types beyond beta cells. Pancreatic polypeptide (PP) is, besides insulin, the sole hormone that is specific to islets of Langerhans. The aim of the DIAPP study was to evaluate if PP secretion is also altered when T1D is complicated by exocrine failure.

Materials and Methods

. - Seven patients with T1D and normal pancreatic function (T1DN), 9 patients with T1D and exocrine failure (T1DEF) were compared to 13 patients with type 3c diabetes; i. e. with chronic pancreatitis (CP). All of them had a mixed meal test (MMT), C-peptide and PP being determined before and at 60, 90 and 120 minutes.

Results

. – The area under the curve of C-peptide during MMT (AUC_Cpep) was significantly greater in the CP group than in both T1D groups (P < 0.0001 vs. the T1DEF group and P < 0.001 vs. the T1D group) while the area under the curve of PP (AUC_PP) was significantly smaller in the CP group than in both T1D groups (P < 0.01 vs. both groups). The AUC_PP / AUC_Cpep ratio was higher in the CP group than in both T1D groups (P < 0.0001 vs. both groups).

Conclusion

. - PP secretion was altered specifically in patients with CP, not in T1D, even when associated with pancreatic exocrine failure.

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Keywords : Chronic pancreatitis, C-peptide, Pancreatic polypeptide, Type 1 diabetes

Plan

Clinical characteristics of the patients

Pancreatic polypeptide during MMT

Discussion

CRediT authorship contribution statement

	The DiaPP study was registered on ClinicalTrials.gov Identifier: NCT03396146
	Disclosure summary: All authors declare that they have no conflict of interest to disclose.
	Acknowledgments: This work was supported by a grant from Assistance Publique Hôpitaux de Paris, Contrat de recherche Clinique and by the Borel bequest.
	Author contribution: LD and LAH recruited the patients, analyzed the data and wrote the manuscript. FBS and JG performed the hormonal assays, interpreted the data and wrote the manuscript, HA designed the study, analyzed the results and wrote the manuscript. EL had the original idea, analyzed the data and wrote the manuscript.
	Conflict of interest disclosure: All authors declare that they have no conflict of interest to disclose.