Diagnosis and risk factors in pancreatogenic diabetes

Pancreatogenic diabetes, i.e. Type 3c Diabetes Mellitus (T3c), is a distinct clinical entity primarily caused by underlying pancreatic disorders. These include acute, chronic, or recurrent pancreatitis, traumatic pancreatitis, pancreatic surgery, cystic fibrosis and pancreatic cancer. Although T3c accounts for approximately 10-15 % of all diabetes, its true burden within the spectrum of pancreatic diseases has been explored in only a limited number of studies. T3c is characterised by both endocrine and exocrine pancreatic insufficiency, and is notable for significant glucose fluctuations resulting from pancreatic tissue loss. It is often misdiagnosed as type 2 diabetes mellitus (T2), making it one of the least investigated and most overlooked forms of diabetes in routine clinical practice. This diagnostic gap frequently leads to ineffective treatment strategies and increased morbidity. Accurate diagnosis hinges on identifying the hallmark features of exocrine pancreatic insufficiency (EPI), which is common in T3c but rarely seen in T2. Two key diagnostic tests include fecal pancreatic elastase and fecal fat quantification. Fat excretion> 7 g/day strongly suggests steatorrhea and significant malabsorption. Given the clinical similarities between T3c and T2, improving diagnostic accuracy is crucial. Early recognition of distinguishing features allows for appropriate medical management and tailored treatment plans that address both endocrine and exocrine dysfunction.