Diabetes due to chronic pancreatitis

Background Endocrine pancreatic insufficiency is an important complication of chronic pancreatitis. Misinterpretation of the resulting diabetes type is common and may lead to suboptimal treatment outcome. Objectives Summary of the characteristics and management of diabetes of the exocrine pancreas. Methods Literature search of relevant publications. Results Eighty percent of patients with chronic pancreatitis develop diabetes of the endocrine pancreas (T3cDM). Misinterpretation of the resulting diabetes as type 2 is common and can lead to suboptimal treatment outcome due to delayed treatment adaptions. Risk factors for development of T3cDM include pancreas calcifications, strictures and concrements of the pancreas duct, presence of exocrine insufficiency, smoking and alcohol consumption. Patients with T3cDM show an increased risk of hyperglycaemia, hypoclycaemia and pancreatic cancer. Due to a pronounced insulin deficiency, T3cDM often requires early initiation of intensive insulin treatment. In addition, treatment of the exocrine insufficiency may improve the endocrine insufficiency. Conclusions Patients with chronic pancreatitis should be screened for endocrine and exocrine pancreas insufficiency at least once a year. Mild hyperglycaemia can be treated with an oral antidiabetic drug. However, in case of insufficient control of the glucose metabolism, intensive insulin treatment should be initiated. In case of the first manifestation or worsening of diabetes after an episode of acute pancreatitis and in case of unintended weight loss, the differential diagnose should include pancreatic cancer.