title: Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: recommendations from PancreasFest 2012.
abstract: METHODS
  Diabetes and glucose intolerance are common complications of chronic pancreatitis, yet clinical guidance on their detection, classification, and management is lacking.
  
  
  METHODS
  A working group reviewed the medical problems, diagnostic methods, and treatment options for chronic pancreatitis-associated diabetes for a consensus meeting at PancreasFest 2012.
  
  
  RESULTS
  Guidance Statement 1.1: Diabetes mellitus is common in chronic pancreatitis. While any patient with chronic pancreatitis should be monitored for development of diabetes, those with long-standing duration of disease, prior partial pancreatectomy, and early onset of calcific disease may be at higher risk. Those patients developing diabetes mellitus are likely to have co-existing pancreatic exocrine insufficiency. Guidance Statement 1.2: Diabetes occurring secondary to chronic pancreatitis should be recognized as pancreatogenic diabetes (type 3c diabetes). Guidance Statement 2.1: The initial evaluation should include fasting glucose and HbA1c. These tests should be repeated annually. Impairment in either fasting glucose or HbA1c requires further evaluation. Guidance Statement 2.2: Impairment in either fasting glucose or HbA1c should be further evaluated by a standard 75 g oral glucose tolerance test. Guidance Statement 2.3: An absent pancreatic polypeptide response to mixed-nutrient ingestion is a specific indicator of type 3c diabetes. Guidance Statement 2.4: Assessment of pancreatic endocrine reserve, and importantly that of functional beta-cell mass, should be performed as part of the evaluation and follow-up for total pancreatectomy with islet autotransplantation (TPIAT). Guidance Statement 3: Patients with pancreatic diabetes shall be treated with specifically tailored medical nutrition and pharmacologic therapies.
  
  
  CONCLUSIONS
  Physicians should evaluate and treat glucose intolerance in patients with pancreatitis.
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA 15213, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Rickels
authors.forename: Melena
authors.initials: M
authors.lastname: Bellin
authors.forename: Frederico G S
authors.initials: FG
authors.lastname: Toledo
authors.forename: R Paul
authors.initials: RP
authors.lastname: Robertson
authors.forename: Dana K
authors.initials: DK
authors.lastname: Andersen
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
authors.forename: Randall
authors.initials: R
authors.lastname: Brand
authors.forename: Luca
authors.initials: L
authors.lastname: Frulloni
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
mesh_terms: D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D018149:Glucose Intolerance / Q000175:diagnosis / Q000628:therapy; D005951:Glucose Tolerance Test; D006801:Humans; D016381:Islets of Langerhans Transplantation; D010179:Pancreas / Q000503:physiopathology; D050500:Pancreatitis, Chronic / Q000150:complications*; D014182:Transplantation, Autologous
keywords: Chronic pancreatitis; Diabetes mellitus; GLP-1; Glucose tolerance test; Incretin; Insulin; Pancreatic polypeptide; Pancreatogenic diabetes
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