Diabetes Care
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Diabetes Care 31:S165-S169, 2008
DOI: 10.2337/dc08-s244
© 2008 by the American Diabetes Association
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Section I: Diabetes-What Is New in the Management and Understanding of the Disease?
Original Article

Is Pancreatic Diabetes (Type 3c Diabetes) Underdiagnosed and Misdiagnosed?

Philip D. Hardt, MD, PHD, Mathias D. Brendel, MD, Hans U. Kloer, MD, PHD and Reinhard G. Bretzel, MD, PHD

Third Medical Department and Policlinic, University Hospital Giessen and Marburg, Giessen, Germany

Address correspondence and reprint requests to Philip D. Hardt, Third Medical Department and Policlinic, University Hospital Giessen and Marburg, Giessen, Rodthohl 6, D-35385 Giessen, Germany. E-mail: philip.d.hardt{at}innere.med.uni-giessen.de

Exocrine pancreatic insufficiency is frequently associated with diabetes, with high prevalence in both insulin-dependent or insulin-independent patients. Exocrine pancreatic failure has often been perceived as a complication of diabetes. In contrast, recent clinical observations lead to the notion that nonendocrine pancreatic disease is a critical factor for development rather than a sequel to diabetes. The incidence of diabetes caused by exocrine pancreatic disease appears to be underestimated and may comprise 8% or more of the general diabetic patient population. Nonendocrine pancreas disease can cause diabetes by multiple mechanisms. Genetic defects have been characterized, resulting in a syndrome of both exocrine and endocrine failure. Regulation of β-cell mass and physiological incretin secretion are directly dependent on normal exocrine function. Algorithms for diagnosis and therapy of diabetes should therefore address both endocrine and exocrine pancreatic function.

Abbreviations: FEC, fecal elastase-1 concentration • GLP, glucagon-like peptide


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Copyright © 2008 by the American Diabetes Association.