Is pancreatic diabetes (type 3c diabetes) underdiagnosed and misdiagnosed?
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.
Hardt
Philip D
PD
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
Brendel
Mathias D
MD
Kloer
Hans U
HU
Bretzel
Reinhard G
RG
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
C054621:CEL protein, human; D008049:Lipase