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
- 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
Abstract
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.
Footnotes
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The authors of this article have no relevant duality of interest to declare.
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This article is based on a presentation at the 1st World Congress of Controversies in Diabetes, Obesity and Hypertension (CODHy). The Congress and the publication of this article were made possible by unrestricted educational grants from MSD, Roche, sanofi-aventis, Novo Nordisk, Medtronic, LifeScan, World Wide, Eli Lilly, Keryx, Abbott, Novartis, Pfizer, Generx Biotechnology, Schering, and Johnson & Johnson.
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