title: Is pancreatic diabetes (type 3c diabetes) underdiagnosed and misdiagnosed?
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 beta-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.
authors.affiliation: Third Medical Department and Policlinic, University Hospital Giessen and Marburg, Giessen, Rodthohl 6, D-35385 Giessen, Germany. philip.d.hardt@innere.med.uni-giessen.de
authors.forename: Philip D
authors.initials: PD
authors.lastname: Hardt
authors.forename: Mathias D
authors.initials: MD
authors.lastname: Brendel
authors.forename: Hans U
authors.initials: HU
authors.lastname: Kloer
authors.forename: Reinhard G
authors.initials: RG
authors.lastname: Bretzel
mesh_terms: D048909:Diabetes Complications / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000145:classification* / Q000235:genetics / Q000503:physiopathology*; D003937:Diagnosis, Differential; D006801:Humans; D050417:Insulin-Secreting Cells / Q000473:pathology / Q000502:physiology; D008049:Lipase / Q000235:genetics; D009154:Mutation; D010179:Pancreas / Q000473:pathology; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence
chemical_list: C054621:CEL protein, human; D008049:Lipase