Management Of Pancreatogenic Diabetes: Challenges And Solutions
Go to: Introduction Pancreatogenic diabetes is a form of secondary diabetes, classified by the American Diabetes Association (ADA) and the World Health Organization as type 3c diabetes mellitus (T3cDM).1,2 It refers to diabetes due to diseases of the exocrine pancreas: pancreatitis (acute, relapsing, or chronic pancreatitis of any etiology), pancreatectomy/trauma, neoplasia, cystic fibrosis, hemochromatosis, and fibrocalculous pancreatopathy.3 With the exception of cancer, damage to the pancreas must be extensive enough for diabetes to occur.1,2 Rather scarce data on T3cDM suggest that most cases result from chronic pancreatitis, as this condition was identified as the underlying disease in 78.5% of all patients with T3cDM.4 In Western populations, T3cDM is estimated to occur in 5%–10% of all diabetic patients, mostly due to chronic pancreatitis.4–6 True prevalence of T3cDM is unknown – data are scarce, mostly due to challenges with accurate diabetes classification in clinical practice.4,7–9 Many T3cDM patients are initially misclassified due to underrecognized contribution of pancreatic disease to the development of diabetes. In order to improve diagnosis, diagnostic criteria for T3cDM have been proposed by Ewald and Bretzel which include 1) the presence of pancreatic exocrine insufficiency, 2) evidence of pathological pancreatic imaging, and 3) the absence of type 1 diabetes mellitus (T1DM)-associated autoantibodies.6 They may be further supported by additional minor criteria, such as an absent pancreatic polypeptide (PP) response to mixed-nutrient ingestion.6 These criteria may be more reliably applied at the presentation of diabetes due to a degree of overlap in established insulin deficiency (related to pancreatic atrophy and exocrine insufficiency). It is Continue reading >>
I Have Type 3c Diabetes – What Is That All About?
This week is #NationalDiabetesWeek and social media has been full of interesting facts and hints and tips on how to manage either Type 1 or Type 2 diabetes. What I have noticed though is that no-one has, thus far, mentioned Type 3 diabetes. This hasn’t come as a surprise. A year before I was diagnosed with operable pancreatic cancer, I was told that I may have Type 2 diabetes. However, I wasn’t overweight, nor did I have a family history of the disease. We now know that it was probably the cancer causing the blood sugar level elevations and this link between new-onset diabetes without weight gain (which can occur 1-3 years before a pancreatic cancer diagnosis) is something that we at Pancreatic Cancer Action are investigating in our research programmes. For all of these years (nearly 9) I have believed that I have Type 2 diabetes. However, at a recent consultation with my new Diabetologist, I discovered that I have in fact got Type 3c Diabetes. This I had never heard of before and so went about trying to find out more. I looked at some informed websites including Diabetes UK and found nothing. Not even a mention. And not all of the medical profession has heard of this type of diabetes either – unless they are specialists in this field. Never being one to give up, I kept on researching. I have since found out that, of all diabetes cases Type 3c makes up about 8%1 – not a lot, but not insignificant either. Type 3c Diabetes is usually characterised by the fact that the patient has had all or part of their pancreas resected due to cancer or cystic lesions or other diseases of the pancreas such as pancreatitis and cystic fybrosis.2 Patients often have Pancreatic Exocrine Insufficiency (malabsorption) and are on Pancreatic Enzyme Therapy (PERT) to help them get their Continue reading >>
Pancreatogenic (type 3c) Diabetes
1. Definition Pancreatogenic diabetes is a form of secondary diabetes, specifically that associated with disease of the exocrine pancreas. The most common disease of the exocrine pancreas associated with the development of diabetes is chronic pancreatitis. Analogous to chronic pancreatitis-associated diabetes is cystic fibrosis-related diabetes (CFRD), in which pancreatic exocrine insufficiency pre-dates the pancreatic endocrine insufficiency responsible for the development of diabetes. Because diabetes in cystic fibrosis is associated with worse nutritional status, more severe inflammatory lung disease, and greater mortality from respiratory failure, CFRD has long been recognized as a distinct form of diabetes requiring a specified approach to evaluation and treatment (30) now recognized by the American Diabetes Association (28). While the distinct pathogenesis of diabetes in chronic pancreatitis has also long been appreciated, only recently have guidelines been developed supporting a specified diagnostic and therapeutic algorithm (37). Finally, other less common forms of pancreatogenic diabetes exist, such as that due to pancreatic cancer (18), as well as post-pancreatectomy diabetes, with each requiring individualized approaches to care. 2. Classification Pancreatogenic diabetes is classified by the American Diabetes Association and by the World Health Organization as type 3c diabetes mellitus (T3cDM) and refers to diabetes due to impairment in pancreatic endocrine function related to pancreatic exocrine damage due to acute, relapsing and chronic pancreatitis (of any etiology), cystic fibrosis, hemochromatosis, pancreatic cancer, and pancreatectomy, and as well rare causes such as neonatal diabetes due to pancreatic agenesis (1). Prevalence data on T3cDM are scarce b Continue reading >>
There’s A Third, Newly-identified Type Of Diabetes
Most people are familiar with type-1 and type-2 diabetes. Recently, though, a new type of diabetes has been identified: type-3c diabetes. Type-1 diabetes is where the body’s immune system destroys the insulin producing cells of the pancreas. It usually starts in childhood or early adulthood and almost always needs insulin treatment. Type-2 diabetes occurs when the pancreas can’t keep up with the insulin demand of the body. It is often associated with being overweight or obese and usually starts in middle or old age, although the age of onset is decreasing. Type-3c diabetes is caused by damage to the pancreas from inflammation of the pancreas (pancreatitis), tumors of the pancreas, or pancreatic surgery. This type of damage to the pancreas not only impairs the organ’s ability to produce insulin but also to produce the proteins needed to digest food (digestive enzymes) and other hormones. However, our latest study has revealed that most cases of type-3c diabetes are being wrongly diagnosed as type-2 diabetes. Only 3% of the people in our sample—of more than 2 million—were correctly identified as having type-3c diabetes. Small studies in specialist centers have found that most people with type-3c diabetes need insulin and, unlike with other diabetes types, can also benefit from taking digestive enzymes with food. These are taken as a tablet with meals and snacks. Researchers and specialist doctors have recently become concerned that type-3c diabetes might be much more common than previously thought and that many cases are not being correctly identified. For this reason, we performed the first large scale population study to try and find out how common type-3c diabetes is. We also looked into how well people with this type of diabetes have their blood sugar contro Continue reading >>
Pancreatogenic diabetes, also known as Type 3C diabetes, results from pancreatic disease (such as chronic pancreatitis) or surgery on the pancreas. A grayish pink gland located in the abdomen, the pancreas essentially has a dual function: The exocrine pancreas secretes important digestive enzymes into the gastrointestinal tract, while the endocrine pancreas secretes the hormones insulin and glucagon into the bloodstream to regulate carbohydrate metabolism. In diabetes, the beta cells of the pancreas no longer make enough insulin to meet the body’s needs, leading to elevated levels of glucose in the blood. Even though diabetes is primarily a disease of the endocrine pancreas, scientists now know that diseases of the exocrine pancreas — or surgery on the pancreas — can also lead to diabetes. They have dubbed this type of diabetes pancreatogenic diabetes, or Type 3C diabetes. Chronic pancreatitis (inflammation of the pancreas), hemochromatosis (a disease of iron metabolism), cystic fibrosis (an inherited disorder of the pancreas and other exocrine glands that produces abnormally thick secretions), pancreatic cancer, and previous surgery on the pancreas have all been associated with diabetes. It is estimated that Type 3C diabetes accounts for 5% to 10% of diabetes diagnoses in western populations and that chronic pancreatitis accounts for 75% of this type of diabetes. Scientists are still trying to figure out exactly what causes pancreatogenic diabetes. They have noted that a single genetic mutation can impair both endocrine and exocrine functions of the pancreas. Furthermore, certain pancreatic diseases can disturb the regeneration of beta cells within the pancreas that manufacture and secrete insulin, thus causing diabetes in patients with chronic pancreatitis. Scie Continue reading >>
There’s A Third Type Of Diabetes—and Doctors Are Misdiagnosing It As Type 2
Syda Productions/Shutterstock There are many surprising facts about type 2 diabetes, including the fact that sometimes it’s actually something else. Say hello to a new form of diabetes. It’s called type 3c diabetes and may be commonly mistaken for type 2 diabetes, the form of the disease most closely linked to obesity, a new study suggests. As a result, many people with type 3c diabetes may not be getting the care they need to keep the eventual consequences of diabetes, such as eye, nerve, and kidney damage, at bay, the researchers warn in Diabetes Care. Type 3c diabetes follows disease of the pancreas and is also called pancreatogenic diabetes, explains study author Simon de Lusignan, BSc, MB BS, MSc, MD(Res), professor of primary care and clinical informatics, the chair in health care management, and head of the department of clinical and cxperimental medicine at University of Surrey in Guildford, UK. “After pancreas disease, it is possible to develop diabetes. The people who do should be labeled type 3c. This is often not thought about, and they are instead labeled as type 2.” Some 88 percent of people who had type 3c diabetes in the study were misdiagnosed as having type 2 over a 10-year period. Put another way: Just 3 percent of the people in the study were correctly identified as having type 3c diabetes. The pancreas is intricately involved in all forms of diabetes. Located behind the lower part of the stomach, this organ is charged with producing insulin, the hormone that helps the body use glucose (blood sugar) in foods for energy. It plays a crucial role in the differences between type 1 and type 2: In type 1 diabetes, the pancreas stops producing insulin altogether. In type 2 diabetes, your body does not use insulin properly. In these cases, the pancre Continue reading >>
Diabetes Symptoms: Have You Been Misdiagnosed With Type 2? Signs You Have Type 3c
Diabetes sufferers are mostly made up of type 2, with 90 per cent of those diagnosed identified as having it compared to just 10 per cent with type 1. However, there is a now a third form of the condition - type 3c - and it is commonly being misdiagnosed as type 2. The University of Surrey discovered that, in adults, type 3c was more common than type 1, which affects 400,000 people in the UK. Unlike type 3c, the differences between type 1 and type 2 are well known. Type 3c, on the other hand, is caused by damage to the pancreas from inflammation of the pancreas, tumours of the pancreas, or pancreatic surgery. The former is where the body's immune system destroys the insulin producing cells of the pancreas. In the latter, the pancreas can't keep up with the insulin demand of the body. The result of both is that glucose - or sugar - levels can rise too high in the bloodstream, triggering diabetes symptoms such excessive thirst, unexplained weight loss and fatigue. Type 3c, on the other hand, is caused by damage to the pancreas from inflammation of the pancreas, tumours of the pancreas, or pancreatic surgery. Fri, August 19, 2016 Diabetes is a common life-long health condition. There are 3.5 million people diagnosed with diabetes in the UK and an estimated 500,000 who are living undiagnosed with the condition. This stops the pancreas from producing insulin, and also producing proteins needed to digest food and other hormones. A study by the University of Surrey has found that most cases of type 3c diabetes are being wrongly diagnosed as type 2 diabetes. Researchers discovered that in a sample of more than two million, just three per cent were correctly identified as having it. This is important since treatment may be slightly different for those with type 3c. Previous stud Continue reading >>
Type 3c (pancreatogenic) Diabetes Mellitus Secondary To Chronic Pancreatitis And Pancreatic Cancer
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. Continue reading >>
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 β-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. PREVALENCE OF PANCREATIC EXOCRINE INSUFFICIENCY IN PATIENTS WITH DIABETES— In recent years, the evaluation of exocrine pancreatic function has been greatly facilitated by newly available noninvasive stool tests allowing screening of large patient populations. Measurement of fecal elastase-1 concentrations (FECs) by enzyme-linked immunosorbent assay based on monoclonal human specific antibodies has become a standard diagnostic parameter with good correlation to direct tests of pancreatic exocrine function (12) and morphological pancreas alterations (13), albeit limited sensitivity in mild pancreatic exocrine insufficiency. Exocrine pancreatic function using FEC assessment has been extensively studied in patients with diabetes. Normal exocrine function (FEC >200 μg/g) was observed in ∼58% of patie Continue reading >>
Type 3c Diabetes Being Misdiagnosed With Type 2 Diabetes, Say Researchers
Pancreatitis is leading to misdiagnoses of type 2 diabetes in people who actually have type 3c diabetes, researchers say. A UK study involving two million people has found 97.3 per cent of those who had previously suffered from pancreatic disease (acute pancreatitis or chronic pancreatic disease) had been wrongly told they had type 2 diabetes when, in fact, they actually had type 3c diabetes. Type 3c diabetes, also known as pancreatogenic diabetes, is not as well known compared to type 1 diabetes and type 2 diabetes. It develops when the pancreas becomes inflamed, or part of it is removed, and eventually stops producing insulin. Type 3c diabetes requires insulin therapy straight away, and wrongly diagnosing someone with type 2 diabetes means there can be a significant delay in a patient receiving the correct treatment. University of Surrey researchers also found type 3c diabetes was more common than previously thought, with significantly more people diagnosed with type 3c diabetes compared to type 1 diabetes. Senior author of the report, Professor Simon de Lusignan from the University of Surrey, said: "Greater awareness of type 3c diabetes within the medical profession is required immediately to improve management of this disease, which now has a higher incidence than type 1 diabetes in adults. "Our research shows that the majority of people with type 3c diabetes are being misdiagnosed with type 2 diabetes, putting both their short and long term health at risk. Diabetes and its complications place a tremendous burden on the NHS and it is important that patients are diagnosed quickly and correctly, helping them get the specific care they need. "This builds on our previous work that suggests that failure to flag the right diagnosis is associated with lower quality care." Continue reading >>
Type 3c Diabetes Is Often Misdiagnosed, Potentially Delaying Pancreatic Cancer Diagnoses
While most people are familiar with types 1 and 2 diabetes, there is a third, less common type, known as 3c, that occurs as a result of a pancreatic disorder – such as pancreatic cancer. New research suggests that even doctors aren’t as familiar as they should be with the third type of diabetes, which leads to patients being misdiagnosed with type 2 diabetes rather than 3c. “The relationship between diabetes and pancreatic cancer is quite complex,” said Lynn Matrisian, PhD, MBA, chief science officer at the Pancreatic Cancer Action Network (PanCAN). “Evidence has shown that diabetes can be both a risk factor and an early symptom of pancreatic cancer.” Pancreatic cancer may cause only vague unexplained symptoms. Pain (usually in the abdomen or back), weight loss, jaundice (yellowing of the skin and/or eyes) with or without itching, loss of appetite, nausea, change in stool, pancreatitis and recent-onset diabetes are symptoms that may indicate pancreatic cancer. If you are experiencing one or more of these symptoms, we urge you to speak to your doctor immediately and reference pancreatic cancer. Matrisian continued: “The results from this study are particularly important because patients with type 3c diabetes may respond to different treatments than type 2 diabetics.” Interestingly, a correct diagnosis of type 3c diabetes can provide a clue to a doctor to look more closely for an underlying pancreatic tumor or other disorder. Around 0.5 to 1 percent of patients diagnosed with new-onset diabetes are diabetic because of an undiagnosed pancreatic tumor. Therefore, researchers are carefully evaluating this relationship as an opportunity to detect pancreatic cancer earlier. “Last year, we at PanCAN offered a new Early Detection Targeted Grant to researchers, Continue reading >>
Diabetes Type 3c?
Little-known diabetes type—caused by pancreas-related problems—is often misdiagnosed and mistreated a new UK study finds It’s not Type 1…and it’s not Type 2. When researchers from the UK’s University of Surrey checked the health records of 2.3 million adults for a new study published in the November issue of Diabetes Care, they uncovered more cases than expected of a little-known blood sugar problem: Diabetes type 3c. And most were misdiagnosed, meaning people with “3c” may not have gotten the best treatment. Type 3c is “diabetes that acts differently,” according to study co-author Andrew McGovern, a research fellow at the University of Exeter and honorary clinical researcher at the University of Surrey. It’s caused by damage to the pancreas—the gland that contains insulin-producing islet cells—from inflammation (pancreatitis), surgery or cancer. The damage knocks out some, but not all, islet cells, reducing insulin levels in the body. In contrast, type 1 diabetes is triggered by an immune-system attack that knocks out virtually all of a person’s islet cells and type 2 happens when the pancreas can’t make enough insulin to overcome insulin resistance. The study looked at new cases of diabetes. It found 559 people with probable type 3c. It was more common than new type 1 diabetes in adults (354 had that type), which surprised the researchers. More concerning: 88% with type 3c were misdiagnosed as type 2s. That’s a problem, because conventional type 2 drugs that boost insulin sensitivity and insulin production may not work well for 3cs. They were “twice as likely to have poor blood sugar control as those with type 2 diabetes,” McGovern says. “They were also five to ten times more likely to need insulin.” Getting the wrong diagnosis Continue reading >>
Type 3c Diabetes: More Common Than Type 1 And Often Misdiagnosed As Type 2
While type 2 diabetes often goes undetected and undiagnosed and type 1 diabetes is often caught too late or confused for type 2 diabetes in adults, there is another type of diabetes out there that patients have which is often not recognized. A new study published in the journal Diabetes Care writes that some people’s health is at risk due to “the failure of doctors to recognise which type of diabetes they have,” Researchers from the University of Surrey looked at primary care records of over 2 million patients and analyzed the frequency of different diabetes diagnosis and how accurate the diagnosis were. They gave special attention to a type of diabetes referred to as type 3c diabetes which is also known as pancreatogenic diabetes or diabetes of the exocrine pancreas. This type of diabetes “occurs as a result of pancreatic inflammation, abnormal growth of tissue on the organ or surgically removing part or all of the tissue, which affects the body’s ability to produce insulin,” states a press release from the University. Many Diagnosed With Type 1 or Type 2 Diabetes Have Type 3c? Researchers found that up to 97.3 percent of people who had pancreatic disease at some point in life are generally diagnosed with type 2 diabetes when they really have type 3c diabetes. This is problematic because treatment for type 3c diabetes generally requires insulin before those with type 2 require it. Not getting the right treatment can cause high blood sugars that lead to complications such as nerve, eye, and kidney damage. Researchers also found that adults are more likely to develop type 3c diabetes thank type 1 diabetes. In the study, 205 more people were newly diagnosed with type 3c diabetes than with type 1 diabetes. This means that type 3c diabetes may be a more common o Continue reading >>
Awareness Of Type 3c Diabetes And Why It Is Misdiagnosed
Diabetes has long been divided into type 1 and type 2. But a third type has entered the mix — and we aren’t diagnosing it correctly. Type 1 diabetes occurs when the pancreas doesn’t produce insulin and is usually diagnosed at a young age. Type 2 diabetes shows up later in life when the pancreas can’t make enough insulin to keep up with the body. This new third type, Type 3c, starts with a damaged pancreas. The researchers say that pancreatitis is leading to misdiagnoses of type 2 diabetes in people who actually have type 3c diabetes. A new study involving two million people has found 97.3% of those who had previously suffered from pancreatic disease (acute pancreatitis or chronic pancreatic disease) had been wrongly diagnosed with type 2 diabetes when, in fact, they actually had type 3c diabetes, despite a sevenfold increased insulin requirement within 5 years, by which time 45.8% of patients with diabetes following chronic pancreatic disease are using insulin. Type 3c diabetes, also known as pancreatogenic diabetes, is not as well known compared to type 1 and type 2 diabetes. It develops when the pancreas becomes inflamed, or part of it is removed and eventually stops producing insulin. A recent study from the American Diabetes Association found only 3 percent of people with type 3c have actually received a correct diagnosis. These misdiagnoses mean people with type 3c might not be getting effective treatments. People diagnosed with type 3c require insulin, but may also benefit from taking digestive enzyme tablets, one of the study’s researchers wrote. That alternative treatment option is what sets type 3c apart from the other types. Correctly identifying the type of diabetes is important as it helps the selection of the correct treatment. Several drugs used Continue reading >>
What Is Type 3c Diabetes?
A group of scientists is warning that doctors need to be more aware of a type of diabetes that has been newly studied in recent years, which they say is poorly understood by many doctors and commonly misdiagnosed. As a result, patients with this form of diabetes, called Type 3c, often aren’t getting the treatment they need. By way of review: Type 1 diabetes, which often shows up in childhood or early adulthood, is an autoimmune disease affecting the insulin-producing cells of the pancreas. Type 2 diabetes, which has generally been associated with middle-aged and older people, is caused by the body’s inability to use insulin properly. Type 3c, described in a new study in the journal Diabetes Care, stems from damage to a previously healthy pancreas, caused by such health issues as pancreatitis, a pancreatic tumor, cystic fibrosis or trauma. As a result, the pancreas no longer produces adequate amounts of insulin, digestive enzymes and other hormones. According to some earlier journal articles on Type 3c, most of the cases occur among people with chronic pancreatitis. Yet, according to the study by a group of British scientists, doctors routinely mistake Type 3c diabetes for Type 2. Writing in the website The Conversation, one of the researchers said the study found that only 3 percent of people with Type 3c diabetes were correctly diagnosed. The mistake can be mean they’re not getting the treatment they need. “Small studies in specialist centers have found that most people with Type 3c diabetes need insulin and, unlike other diabetes types, can also benefit from taking digestive enzymes with food,” wrote the researcher, Andrew McGovern at the University of Surrey. In order to find patients with Type 3c, the researchers looked at close to 38,000 adult patients wh Continue reading >>