J Korean Diabetes.  2017 Sep;18(3):150-154. 10.4093/jkd.2017.18.3.150.

Pancreatogenic Diabetes

• Kim JH

• KMID: 2390867
• DOI: http://doi.org/10.4093/jkd.2017.18.3.150

Abstract

Diabetes can develop as a direct consequence of diseases of the exocrine pancreas. Diabetes due to diseases of the exocrine pancreas is described as pancreatogenic diabetes or type 3c diabetes. Pancreatogenic diabetes is not commonly recognized by clinicians and is frequently misclassified as type 1 diabetes or, more commonly, type 2 diabetes. The prevalence and clinical importance of pancreatogenic diabetes have been underestimated and underappreciated. Pancreatogenic diabetes has a unique pattern of hormonal and metabolic characteristics. The failure to correctly diagnose pancreatogenic diabetes leads to failure to implement an appropriate medical therapy in these patients. We will review the clinical implications and relevance of pancreatogenic diabetes.

Keyword

Diabetes mellitus; Exocrine pancreas; Pancreas

MeSH Terms

Diabetes Mellitus
Humans
Pancreas
Pancreas, Exocrine
Prevalence

Reference

References

1. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003; 26(Suppl 1):S5–20.

2. Vujasinovic M, Zaletel J, Tepes B, Popic B, Makuc J, Epsek Lenart M, Predikaka M, Rudolf S. Low prevalence of exocrine pancreatic insufficiency in patients with diabetes mellitus. Pancreatology. 2013; 13:343–6.

3. Howes N, Lerch MM, Greenhalf W, Stocken DD, Ellis I, Simon P, Truninger K, Ammann R, Cavallini G, Charnley RM, Uomo G, Delhaye M, Spicak J, Drumm B, Jansen J, Mountford R, Whitcomb DC, Neoptolemos JP. European Registry of Hereditary Pancreatitis and Pancreatic Cancer (EUROPAC). Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol. 2004; 2:252–61.

4. Ewald N, Kaufmann C, Raspe A, Kloer HU, Bretzel RG, Hardt PD. Prevalence of diabetes mellitus secondary to pancreatic diseases (type 3c). Diabetes Metab Res Rev. 2012; 28:338–42.

5. Ewald N, Bretzel RG. Diabetes mellitus secondary to pancreatic diseases (Type 3c)–are we neglecting an important disease? Eur J Intern Med. 2013; 24:203–6.

6. Hart PA, Bellin MD, Andersen DK, Bradley D, Cruz-Monserrate Z, Forsmark CE, Goodarzi MO, Habtezion A, Korc M, Kudva YC, Pandol SJ, Yadav D, Chari ST. Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer(CPDPC). Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol. 2016; 1:226–37.

7. Rebours V, Boutron-Ruault MC, Schnee M, Férec C, Le Maréchal C, Hentic O, Maire F, Hammel P, Ruszniewski P, Lévy P. The natural history of hereditary pancreatitis: a national series. Gut. 2009; 58:97–103.

8. Tiengo A, Segato T, Briani G, Setti A, Del Prato S, Devidé A, Padovan D, Virgili F, Crepaldi G. The presence of retinopathy in patients with secondary diabetes following pancreatectomy or chronic pancreatitis. Diabetes Care. 1983; 6:570–4.

9. Cui Y, Andersen DK. Diabetes and pancreatic cancer. Endocr Relat Cancer. 2012; 19:F9–26.

10. Liao KF, Lai SW, Li CI, Chen WC. Diabetes mellitus correlates with increased risk of pancreatic cancer: a population-based cohort study in Taiwan. J Gastroenterol Hepatol. 2012; 27:709–13.

11. Munigala S, Singh A, Gelrud A, Agarwal B. Predictors pancreatic cancer diagnosis following new-onset diabetes mellitus. Clin Transl Gastroenterol. 2015; 6:e118.

12. Brodovicz KG, Kou TD, Alexander CM, O'Neill EA, Engel SS, Girman CJ, Goldstein BJ. Impact of diabetes duration and chronic pancreatitis on the association between type 2 diabetes and pancreatic cancer risk. Diabetes Obes Metab. 2012; 14:1123–8.

13. Ewald N, Hardt PD. Diagnosis and treatment of diabetes mellitus in chronic pancreatitis. World J Gastroenterol. 2013; 19:7276–81.

14. Alberti KGMM. Diabetes secondary to pancreatopathy: an example of brittle diabetes. In: Tiengo A, Alberti KGMM, Del Prato S, Vranic M, eds. Diabetes secondary to pancreatopathy: proceedings of the Post EASD International Symposium on Diabetes Secondary to Pancreatopathy, Padova, Italy, 21–22 September 1987. Amsterdam: Excerpta Medica;. 1988. 211–4.

15. Sadeghi N, Abbruzzese JL, Yeung SC, Hassan M, Li D. Metformin use is associated with better survival of diabetic patients with pancreatic cancer. Clin Cancer Res. 2012; 18:2905–12.

16. Elashoff M, Matveyenko AV, Gier B, Elashoff R, Butler PC. Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1-based therapies. Gastroenterology. 2011; 141:150–6.

17. Chari ST, Leibson CL, Rabe KG, Ransom J, de Andrade M, Petersen GM. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005; 129:504–11.

18. Damiano J, Bordier L, Le Berre JP, Margery J, Dupuy O, Mayaudon H, Bauduceau B. Should pancreas imaging be recommanded in patients over 50 years when diabetes is discovered because of acute symptoms? Diabetes Metab. 2004; 30:203–7.

19. Illés D, Terzin V, Holzinger G, Kosár K, Róka R, Zsóri G, Ábrahám G, Czakó L. New-onset type 2 diabetes mellitus–A high-risk group suitable for the screening of pancreatic cancer? Pancreatology. 2016; 16:266–71.

20. Hart PA, Kamada P, Rabe KG, Srinivasan S, Basu A, Aggarwal G, Chari ST. Weight loss precedes cancer-specific symptoms in pancreatic cancer-associated diabetes mellitus. Pancreas. 2011; 40:768–72.

21. Hart PA, Baichoo E, Bi Y, Hinton A, Kudva YC, Chari ST. Pancreatic polypeptide response to a mixed meal is blunted in pancreatic head cancer associated with diabetes mellitus. Pancreatology. 2015; 15:162–6.