Pancreatogenic diabetes: Pathophysiology, diagnosis, and management challenges

Abstract

Pancreatogenic diabetes, also known as type 3c diabetes, arises from pancreatic dysfunction due to conditions such as chronic pancreatitis and pancreatic cancer. This form of diabetes is characterized by both endocrine and exocrine pancreatic insufficiency, leading to insulin deficiency, glycemic variability, and maldigestion. The diagnostic process remains complex, as it shares clinical features with type 2 diabetes, and there are no standardized diagnostic criteria. Current treatment approaches include insulin therapy and pancreatic enzyme replacement therapy, along with nutritional support. However, the efficacy of oral hypoglycemic agents is limited, particularly in the presence of exocrine insufficiency. Epidemiological data indicate a significant overlap between pancreatogenic diabetes and pancreatic cancer, necessitating enhanced screening in high-risk populations. In this minireview, we highlight the pathophysiological mechanisms, diagnostic challenges, and current management strategies, emphasizing the need for improved diagnostic criteria and individualized treatment regimens.

Keywords: Pancreatogenic diabetes; Chronic pancreatitis; Insulin therapy; Pancreatic enzyme replacement therapy; Glycemic control; Pancreatic cancer

Core Tip: Pancreatogenic diabetes is a distinct form of diabetes that results from pancreatic dysfunction, commonly seen in chronic pancreatitis and pancreatic cancer. Accurate diagnosis requires a comprehensive approach involving clinical history, imaging, and biochemical markers. Treatment typically includes insulin therapy, pancreatic enzyme replacement, and nutritional support. Given the association with pancreatic cancer, ongoing surveillance and early detection in high-risk groups are essential. Standardized diagnostic criteria and evidence-based treatment guidelines are urgently needed to improve patient care.