Approach to the Patient With Pancreatogenic Diabetes

Diabetes can occur secondary to a wide array of exocrine pancreas pathologies. Pancreatogenic diabetes is a broad diagnostic term used to encompass these disparate causes of diabetes, which taken together are estimated to account for 1% to 9% of all cases of diabetes. The more common causes of pancreatogenic diabetes include pancreatitis, pancreatic ductal adenocarcinoma, cystic fibrosis, pancreatectomy, and fibrocalculous pancreatic disease. Persons with these exocrine pancreatic conditions should be screened for diabetes. Reciprocally, clinicians should consider the possibility of underlying pancreatic disease in persons with diabetes. Of special concern, diabetes can be the presenting sign of pancreatic ductal adenocarcinoma, for which clinical suspicion remains crucial as there are not yet distinguishing biomarkers. Timely diagnosis of diabetes is especially important in cystic fibrosis, because even mild diabetes can worsen lung disease and mortality risk in this condition. Exocrine pancreatic insufficiency is present in many cases of pancreatogenic diabetes. In these cases, provision of pancreatic enzyme replacement therapy may improve glycemic control. Optimal screening and treatment approaches are evolving, differing depending on the specific pancreatic pathology. Clinicians should be vigilant for exocrine pancreas symptomatology, including abdominal pain, steatorrhea, and malabsorption in their patients with diabetes.