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.
- DIABETES CARE
