Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer

doi:10.1016/S2468-1253(16)30106-6

Review

. 2016 Nov;1(3):226-237.

doi: 10.1016/S2468-1253(16)30106-6. Epub 2016 Oct 12.

Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer

Affiliations

¹ Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: philip.hart@osumc.edu.
² Division of Pediatric Endocrinology and Schulze Diabetes Institute, University of Minnesota Medical Center, Minneapolis, MN, USA.
³ Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
⁴ Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
⁵ Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁶ Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA.
⁷ Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Departments of Medicine, Biochemistry, and Molecular Biology, Indiana University School of Medicine, Indiana University Simon Cancer Center, Indianapolis, IN, USA; Pancreatic Cancer Signature Center, Indiana University Simon Cancer Center, Indianapolis, IN, USA.
¹⁰ Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.
¹¹ Department of Veterans Affairs, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹² Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA, USA.
¹³ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

PMID: 28404095
PMCID: PMC5495015
DOI: 10.1016/S2468-1253(16)30106-6

Review

Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer

Phil A Hart et al. Lancet Gastroenterol Hepatol. 2016 Nov.

. 2016 Nov;1(3):226-237.

doi: 10.1016/S2468-1253(16)30106-6. Epub 2016 Oct 12.

Authors

Affiliations

¹ Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: philip.hart@osumc.edu.
² Division of Pediatric Endocrinology and Schulze Diabetes Institute, University of Minnesota Medical Center, Minneapolis, MN, USA.
³ Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
⁴ Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
⁵ Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁶ Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA.
⁷ Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Departments of Medicine, Biochemistry, and Molecular Biology, Indiana University School of Medicine, Indiana University Simon Cancer Center, Indianapolis, IN, USA; Pancreatic Cancer Signature Center, Indiana University Simon Cancer Center, Indianapolis, IN, USA.
¹⁰ Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.
¹¹ Department of Veterans Affairs, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹² Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh and UPMC Medical Center, Pittsburgh, PA, USA.
¹³ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

PMID: 28404095
PMCID: PMC5495015
DOI: 10.1016/S2468-1253(16)30106-6

Abstract

Diabetes mellitus is a group of diseases defined by persistent hyperglycaemia. Type 2 diabetes, the most prevalent form, is characterised initially by impaired insulin sensitivity and subsequently by an inadequate compensatory insulin response. Diabetes can also develop as a direct consequence of other diseases, including diseases of the exocrine pancreas. Historically, diabetes due to diseases of the exocrine pancreas was described as pancreatogenic or pancreatogenous diabetes mellitus, but recent literature refers to it as type 3c diabetes. It is important to note that type 3c diabetes is not a single entity; it occurs because of a variety of exocrine pancreatic diseases with varying mechanisms of hyperglycaemia. The most commonly identified causes of type 3c diabetes are chronic pancreatitis, pancreatic ductal adenocarcinoma, haemochromatosis, cystic fibrosis, and previous pancreatic surgery. In this Review, we discuss the epidemiology, pathogenesis, and clinical relevance of type 3c diabetes secondary to chronic pancreatitis and pancreatic ductal adenocarcinoma, and highlight several important knowledge gaps.

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Conflict of interest statement

Declaration of interests

MDB has received research support outside of the submitted work from Merck & Co, Medtronic, and Dompe pharmaceuticals. STC has received research support outside of the submitted work from Sandler Kenner Foundation, and non-financial support from Kenner Family Research Fund. PAH has received honoraria from Abbvie, as well as consulting fees from KC Specialty Therapeutic. SJP has received research support outside of the submitted work from Calcimedica, and has patents licensed, issued, and pending for intellectual property that is unrelated to the submitted work. DY is consulting for Abbvie and has received royalties for UpToDate publication. DKA, DB, ZC-M, CEF, MOG, AH, MK, and YCK declare no competing interests.

Figures

**Figure. Prevalence and causes of type 3c diabetes mellitus**
(A) Prevalence of type 3c diabetes in a cohort of 1868 participants with diabetes. (B) Frequency of different causes in the 117 participants with type 3c diabetes. Reproduced from Ewald and colleagues, by permission of John Wiley and Sons.

See this image and copyright information in PMC

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References

1. American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care. 2016;39(suppl 1):S13–22. - PubMed
1. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):S5–20. - PubMed
1. 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. - PubMed
1. Xiao AY, Tan MLY, Wu LM, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016 published online June 28. http://dx.doi.org/10.1016/S2468-1253(16)30004-8. - DOI - PubMed
1. Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106:2192–99. - PubMed

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[1] American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care. 2016;39(suppl 1):S13–22. - PubMed

[2] American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care. 2016;39(suppl 1):S13–22. - PubMed

[3] Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):S5–20. - PubMed

[4] Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):S5–20. - PubMed

[5] 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. - PubMed

[6] 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. - PubMed

[7] Xiao AY, Tan MLY, Wu LM, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016 published online June 28. http://dx.doi.org/10.1016/S2468-1253(16)30004-8. - DOI - PubMed

[8] Xiao AY, Tan MLY, Wu LM, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016 published online June 28. http://dx.doi.org/10.1016/S2468-1253(16)30004-8. - DOI - PubMed

[9] Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106:2192–99. - PubMed

[10] Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106:2192–99. - PubMed

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Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer

Affiliations

Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer

Authors

Affiliations

Abstract

Conflict of interest statement

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