This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Diabetes of the exocrine pancreas (DEP)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Dabetes due to diseases of the exocrine pancreas (DEP) was previously described as pancreatogenic or pancreatogenous diabetes mellitus - however recent literature refers to it as type 3c diabetes

  • is far more common than has been previously considered, with a recent study showing 1.8% of adults with new-onset diabetes should have been classified as DEP
    • majority is misdiagnosed as type 2 diabetes mellitus (T2DM)
    • patients have varying degrees of exocrine and endocrine dysfunction
      • damage to the islet of Langerhans effects the secretion of hormones from the alpha, beta, and pancreatic polypeptide cells; the combination of low insulin, glucagon, and pancreatic polypeptide contributes to rapid fluctuations in glucose levels
        • form of "brittle diabetes" may result in the poorer glycemic control observed in patients with DEP/type 3c diabetes
        • patients are more likely to require early insulin initiation compared with those with T2DM
          • individuals should be advised about the symptoms of decompensated hyperglycemia, although they are less likely to develop ketoacidosis (1,2)

  • DEP/ type 3c diabetes is not a single entity
    • occurs because of a variety of exocrine pancreatic diseases with varying mechanisms of hyperglycaemia
    • most commonly identified causes of type 3c diabetes are chronic pancreatitis, pancreatic ductal adenocarcinoma, haemochromatosis, cystic fibrosis, and previous pancreatic surgery
      • distribution of causes for type 3c diabetes consisted of
        • chronic pancreatitis (79%),
        • pancreatic ductal adenocarcinoma (8%),
        • haemochromatosis (7%),
        • cystic fibrosis (4%), and previous pancreatic surgery (2%)

  • two major causative factors in the pathogenesis of diabetes are inadequate pancreatic beta-cell function (type 1 diabetes) and insulin resistance (type 2 diabetes)
    • two factors appear to contribute differentially to the hyperglycaemia observed in patients with type 3c diabetes

  • no universally accepted diagnostic criteria for type 3c diabetes (DEP)
    • diagnosis can be made in patients who meet the three following criteria (2):
      • those who fulfil the diagnostic criteria for diabetes,
      • those who have a disease of the exocrine pancreas, and
      • those whose diabetes is reasonably certain to be secondary to their exocrine pancreatic disease

  • management of DEP/Type 3c diabetes
    • patients with DEP can benefit from specific lifestyle advice, pancreatic enzyme replacement therapy, metformin treatment, appropriate insulin dosing, and monitoring (1)

Notes:

  • should screen for DEP/Type 3 c diabetes in patients with acute or chronic pancreatitis, following pancreatic resection, or with co-existing cystic fibrosis or hemochromatosis
    • incident diabetes may herald the onset of pancreatic ductal carcinoma in a small subset of patients (1)

Reference:

  • Wynne K et al. Diabetes of the exocrine pancreas. J Gastroenterol Hepatol. 2018 Aug 27.
  • 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.
  • Hart PA et al. Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol . 2016 November ; 1(3): 226-237.

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.