Diagnosis and treatment of diabetes mellitus in chronic pancreatitis
Chronic pancreatitis is a disease characterized by pancreatic inflammatory and fibrotic injury resulting in irreversible parenchymal damage. Progressive nutrient maldigestion and disturbance of the timing and the interactions between nutrient digestion and absorption is observed and may lead to severe metabolic derangements. Glucose intolerance and diabetes mellitus are observed quite frequently in the course of the disease[1,2].
Development of diabetes mellitus in chronic pancreatitis mainly occurs due to the destruction of islet cells by pancreatic inflammation. Additionally, nutrient maldigestion leads to an impaired incretin secretion and therefore to a diminished insulin release of the remaining beta-cells. In contrast to the autoimmune mediated destruction of the beta-cells in type 1 diabetes mellitus, glucagon secreting alpha-cells and pancreatic polypeptide secreting pancreatic polypeptide-cells are also subject to destruction in chronic pancreatitis leading to a complex deranged metabolic situation.
Diabetes mellitus secondary to pancreatic diseases (such as chronic pancreatitis) is classified as pancreatogenic diabetes or type 3c diabetes mellitus according to the current classification of diabetes mellitus (Table 1)[4,5]. Whereas the awareness of type 1 and type 2 diabetes mellitus is rather good, type 3c diabetes mellitus, however, is a condition rarely considered in everyday practice. Yet, recent data on type 3c diabetes mellitus show that it might be more common than generally thought. Studies also suggest that this important condition m Continue reading