OBJECTIVE Diabetes frequently develops in patients with chronic pancreatitis. We examined the alterations in the glucagon response to hypoglycemia and to oral glucose administration in patients with diabetes due to chronic pancreatitis.

RESEARCH DESIGN AND METHODS Ten patients with diabetes secondary to chronic pancreatitis were compared with 13 patients with type 2 diabetes and 10 healthy control subjects. A stepwise hypoglycemic clamp and an oral glucose tolerance test (OGTT) were performed.

RESULTS Glucose levels during the OGTT were higher in patients with diabetes and chronic pancreatitis and lower in control subjects (P < 0.0001). Insulin and C-peptide levels were reduced, and the glucose-induced suppression of glucagon was impaired in both groups with diabetes (all P < 0.0001 vs. control subjects). During hypoglycemia, glucagon concentrations were reduced in patients with chronic pancreatitis and with type 2 diabetes (P < 0.05). The increase in glucagon during the clamp was inversely related to the glucose-induced glucagon suppression and positively related to β-cell function. Growth hormone responses to hypoglycemia were lower in patients with type 2 diabetes (P = 0.0002) but not in patients with chronic pancreatitis.

CONCLUSIONS α-Cell responses to oral glucose ingestion and to hypoglycemia are disturbed in patients with diabetes and chronic pancreatitis and in patients with type 2 diabetes. The similarities between these defects suggest a common etiology.

目的糖尿病经常在慢性胰腺炎患者中发展。我们研究了由于慢性胰腺炎对糖尿病患者胰高血糖素对低血糖和口服葡萄糖的反应的变化。

研究设计与方法将10例继发于慢性胰腺炎的糖尿病患者与13例2型糖尿病患者和10例健康对照者进行了比较。进行了逐步降糖钳和口服葡萄糖耐量试验（OGTT）。

结果OGTT期间糖尿病和慢性胰腺炎患者的血糖水平较高，而对照组则较低（P <0.0001）。两组糖尿病患者的胰岛素和C肽水平均降低，并且葡萄糖诱导的胰高血糖素抑制作用减弱（与对照组相比，所有P <0.0001）。低血糖期间，慢性胰腺炎和2型糖尿病患者的胰高血糖素浓度降低（P <0.05）。钳制期间胰高血糖素的增加与葡萄糖诱导的胰高血糖素抑制成反比，与β细胞功能成正比。2型糖尿病患者对低血糖的生长激素反应较低（P = 0.0002），但对于慢性胰腺炎患者则不适用。

结论在糖尿病和慢性胰腺炎患者以及2型糖尿病患者中，α细胞对口服葡萄糖摄入和对低血糖的反应受到干扰。这些缺陷之间的相似性表明了共同的病因。