Fibrocalculous pancreatic diabetes is a form of diabetes secondary to chronic pancreatitis found in tropical, developing countries. There is no population based data

on prevalence of fibrocalculous pancreatic diabetes. This paper reports on prevalence of fibrocalculous pancreatic diabetes in Chennai in South India based on the Chennai Urban

Rural Epidemiology Study

Deepa, M

Farooq, Syed

Mohan, V

Context: Fibrocalculous pancreatic diabetes is a form of diabetes secondary to chronic pancreatitis found in tropical, developing countries. There is no population based data on prevalence of fibrocalculous pancreatic diabetes. Objective This paper reports on prevalence of fibrocalculous pancreatic diabetes in Chennai in South India based on the Chennai Urban Rural Epidemiology Study. Results The prevalence of fibrocalculous pancreatic diabetes is 0.36% (1:276) of all self reported diabetes and 0.019% (1:5,200) of the general population of Chennai. Conclusion: Although the frequency is low, diagnosis of fibrocalculous pancreatic diabetes must be kept in mind in treating diabetic subjects in developing countries as its management would include management of pain, pancreatic enzyme supplements and periodic surveillance for pancreatic malignancy

Mohan, Viswanathan

Deepa, Mohan

Publications of the IAS Fellows

Prevalence of fibrocalculous pancreatic diabetes in Chennai in South India

Eprints @MDRF

JOP. J Pancreas (Online) 2008; 9(4):489-492. 
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 9, No. 4 - July 2008. [ISSN 1590-8577] 489
ORIGINAL ARTICLE 
 
 
Prevalence of Fibrocalculous Pancreatic Diabetes 
in Chennai in South India 
 
 
Viswanathan Mohan, Syed Farooq, Mohan Deepa 
 
 
Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, WHO 
Collaborating Centre for Noncommunicable Diseases Prevention and Control. Chennai, India 
 
 
ABSTRACT 
 
Context Fibrocalculous pancreatic diabetes is 
a form of diabetes secondary to chronic 
pancreatitis found in tropical, developing 
countries. There is no population based data 
on prevalence of fibrocalculous pancreatic 
diabetes. 
 
Objective This paper reports on prevalence of 
fibrocalculous pancreatic diabetes in Chennai 
in South India based on the Chennai Urban 
Rural Epidemiology Study. 
 
Results The prevalence of fibrocalculous 
pancreatic diabetes is 0.36% (1:276) of all 
self reported diabetes and 0.019% (1:5,200) 
of the general population of Chennai. 
 
Conclusion Although the frequency is low, 
diagnosis of fibrocalculous pancreatic 
diabetes must be kept in mind in treating 
diabetic subjects in developing countries as its 
management would include management of 
pain, pancreatic enzyme supplements and 
periodic surveillance for pancreatic 
malignancy. 
 
 
INTRODUCTION 
 
Fibrocalculous pancreatic diabetes (FCPD) 
[1] is a form of diabetes, secondary to tropical 
chronic pancreatitis seen in developing 
countries. FCPD is characterized by insulin 
requiring diabetes and presence of pancreatic 
calculi or other evidence of chronic 
pancreatitis, e.g. dilated pancreatic ducts and 
mutations in the SPINK gene [2]. The term 
tropical chronic pancreatitis is used by 
gastroenterologists who deal primarily with 
the early, pre-diabetic phase of the disease [3] 
while the term FCPD, used by diabetologists 
to denote the later diabetes part of the 
syndrome, was introduced in 1985 by World 
Health Organization (WHO) [4]. In the more 
recent WHO classification of diabetes, FCPD 
is classified under ‘diabetes due to other 
types’ [5]. We have earlier reported on the 
clinical, biochemical, natural history and 
etiology of FCPD [1, 6, 7]. There is only one 
population based study on the prevalence of 
this entity and this dealt with tropical chronic 
pancreatitis and not with FCPD and was done 
in the Kerala state (India) which reportedly 
has the largest number of patients with 
tropical chronic pancreatitis in the world [8]. 
To our knowledge, there is no population 
based study on the prevalence of FCPD. This 
paper reports on the prevalence of FCPD in 
an urban South Indian population. 
 
RESEARCH DESIGN AND METHODS 
 
Study subjects were recruited from the 
Chennai Urban Rural Epidemiology Study 
(CURES), conducted on a representative 
population of Chennai (formerly Madras), the 
fourth largest city in India with a population 
of about 5 million. The methodology of the 
study has been published elsewhere [9]. 
Briefly, in the first phase of CURES, 26,001 
JOP. J Pancreas (Online) 2008; 9(4):489-492. 
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 9, No. 4 - July 2008. [ISSN 1590-8577] 490
individuals aged 20 years or more were 
recruited based on a systematic random 
sampling technique covering all the 
corporation wards of Chennai. Self reported 
diabetic subjects diagnosed by a physician 
and on any drug therapy, were classified as 
‘known’ diabetic subjects. 
A questionnaire elicited demographic, socio-
economic, behavioral and past medical 
history of the study subjects and included 
specific questions related to chronic 
pancreatitis such as the history of recurrent 
abdominal pain and/or passing greasy or oily 
stools. In the second phase of CURES, all 
‘known’ diabetic subjects (n=1,529) were 
invited to the centre for detailed studies and 
all respondents underwent a plain abdominal 
X-ray focused on T12/L1 region as well as 
abdominal ultrasonography to rule out 
pancreatic calculi. 
FCPD was diagnosed based on the following 
criteria [1]: i) presence of pancreatic calculi 
on abdominal X-ray and evidence of ductal 
dilation on ultrasonography; ii) absence of 
alcoholism, or other known causes of chronic 
pancreatitis; iii) evidence of diabetes; i.e., 
fasting plasma glucose equal to, or greater 
than, 7.0 mmol/L (126 mg/dL), or random 
plasma glucose greater than 11.1 mmol/L 
(200 mg/dL), or subject on drug treatment of 
diabetes. 
 
ETHICS 
 
The Madras Diabetes Research Foundation 
ethical committee approval, and written 
informed consent from all study subjects were 
obtained. 
STATISTICS 
 
Data are reported as means, standard 
deviations, and frequencies. Statistical 
analyses were performed by using SPSS for 
Windows version 10.0 software (SPSS Inc., 
Chicago, IL, USA). The Student’s t test was 
used for continuous variable and the Fisher’s 
exact test for dichotomic data. Two-tailed P 
values less than 0.05 were considered 
significant. 
 
RESULTS 
 
Of the 1,529 ‘known’ diabetic subjects, 1,382 
(90.4%) subjects participated to this study. 
There were no significant differences between 
the 1,382 responders and the 147 non-
responders (Table 1). The remaining analyses 
are restricted to data from the responders. 
The mean age of the study population was 
51.7±10.7 years and 46.2% (n=638) of the 
subjects were males. Two-hundred and 20 
subjects (15.9%) were smokers. FCPD was 
diagnosed in 5/1,382 diabetic subjects, 
yielding a prevalence of 0.36% among the 
total ‘known’ diabetic subjects (Figure 1). 
Four of the five patients gave a history of 
recurrent abdominal pain and two patients 
complained of passing greasy/oily stools. 
The characteristics of the FCPD subjects 
(n=5) were compared with the other diabetic 
subjects (n=1,377), all of whom appeared to 
have type 2 diabetes. FCPD patients were 
younger (41.4±18.4 years vs. 51.7±10.7 years; 
P=0.032) and had a lower age at onset of 
diabetes (36.3±15.1 years vs. 46.0±10.0 years 
P=0.031). Body mass index (17.8±3.1 kg/m2 
Table 1. Characteristics of the 1,529 ‘known’ diabetic subjects according to the participation to the study. 
 Responders 
(n=1,382) 
Non-responders 
(n=147) 
Significance 
Age (years) 51.7±10.7 51.3±9.1 P=0.662 
Gender: 
- Males 
- Females 
 
638 (46.2%) 
744 (53.8%) 
 
76 (51.7%) 
71 (48.3%) 
P=0.224 
Fasting plasma glucose (mg/dL) 169±72 a 171±72 P=0.749 
Blood pressure (mmHg): 
- Systolic 
- Diastolic 
 
130±21 a 
78±12 a 
 
128±25 
77±11 
 
P=0.282 
P=0.333 
a 1,381 cases had available data
JOP. J Pancreas (Online) 2008; 9(4):489-492. 
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 9, No. 4 - July 2008. [ISSN 1590-8577] 491
vs. 25.1±4.3 kg/m2; P<0.001), waist 
circumference (74.2±9.0 cm vs. 90.3±10.0 
cm; P<0.001), serum cholesterol (166±42 
mg/dL vs. 201±42 mg/dL; P=0.063) and 
triglyceride (92±32 mg/dL vs. 178±129 
mg/dL, P=0.136) levels were significantly 
lower among FCPD subjects compared to 
type 2 diabetic subjects whereas glycated 
hemoglobin levels were significantly higher 
(12.5±3.1% vs. 8.8±2.3%, P<0.001). All 
FCPD patients required insulin for 
stabilization of the diabetes but none had 
evidence of ketonuria. 
 
CONCLUSIONS 
 
This is the first population based study on 
prevalence of FCPD in the world literature. 
Our study shows that 0.36% of self reported 
diabetic subjects had FCPD. Considering the 
high response rate (90.4%) it may be 
considered that no further cases might be 
present in the 147 diabetic subjects who 
unattended the study. Therefore a 0.019% 
prevalence of FCPD may be estimated in the 
total study population in Chennai in Tamil 
Nadu state (Figure 1). This corresponds to a 
frequency of FCPD of 1:276 among self-
reported diabetic subjects and 1:5,200 in the 
general population. The prevalence in the 
general population is much lower than in 
Kerala where the frequency was reported to 
be about 1:1,000 persons [8]. The Kerala 
study however focused only on presence of 
pancreatic calculi, which can also occur in 
non-diabetic subjects (i.e., tropical chronic 
pancreatitis) while our study only included 
those with diabetes (i.e. FCPD). It is also 
possible that the prevalence of this condition 
is higher in Kerala. 
Earlier clinic based studies had suggested that 
the prevalence of FCPD is higher in states 
like Kerala, Tamil Nadu and Orissa compared 
to the rest of the country [10]. However, 
clinic based data are subject to referral bias. 
In the absence of a national study, it is 
difficult to estimate the prevalence of FCPD 
in other parts of the country. Doing 
abdominal X-rays in a population is a major 
Figure 1. Sampling frame and prevalence of fibrocalculous pancreatic diabetes (FCPD) in Chennai, India. 
JOP. J Pancreas (Online) 2008; 9(4):489-492. 
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 9, No. 4 - July 2008. [ISSN 1590-8577] 492
challenge which explains why such a study 
has not been done earlier. 
Although the prevalence of FCPD is low, this 
entity must be kept in mind in countries 
where its occurrence has been reported. The 
clinical significance of FCPD is that its 
therapy would include, in addition to control 
of diabetes, management of the pain of 
pancreatitis, long term pancreatic enzyme 
replacement and periodic screening for 
pancreatic adenocarcinoma [1, 11, 12]. 
 
 
Received May 1st, 2008 - Accepted May 14th, 
2008 
 
Keywords Calculi; Epidemiology; India; 
Pancreatitis, Chronic; Prevalence 
Abbreviations CURES: Chennai Urban 
Rural Epidemiology Study; FCPD: 
fibrocalculous pancreatic diabetes 
 
Acknowledgements The CURES field 
studies were supported by Chennai 
Willingdon Corporate Foundation. This is the 
61st paper from CURES (CURES - 61) 
 
Conflict of interest The authors have no 
potential conflicts of interest 
 
Correspondence 
Viswanathan Mohan 
Madras Diabetes Research Foundation and 
Dr. Mohan’s Diabetes Specialities Centre 
WHO Collaborating Centre for Noncom-
municable Diseases Prevention and Control 
4, Conran Smith Road 
Gopalapuram, Chennai 
600 086, India 
Phone: +91-44.2835.9048 
Fax: +91-44.2835.0935 
E-mail: drmohans@vsnl.net 
 
Document URL: http://www.joplink.net/prev/200807/13.html  
 
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