Fibrocalculous Pancreatic Diabetes: Changing Clinical Spectrum and Glycaemic Response to Pioglitazone

Fibrocalculous pancreatic diabetes (FCPD) is a unique form of diabetes characterised by irreversible damage to the pancreatic parenchyma with intraductal calcification, progressively leading to beta-cell damage. The classical clinical presentation of FCPD is evolving, with a declining frequency of typical phenotypes and increasing involvement of individuals with normal BMI and older age at presentation. This Study evaluated the clinical and demographic profile of patients with FCPD in North Karnataka and compared the glycaemic response to pioglitazone.

This was a single-centre retrospective observational study done at a tertiary care endocrinology centre. Patients with FCPD diagnosed between December 2019 and December 2024 were retrospectively analysed. Clinical characteristics, imaging and glycaemic data were collected. Patients with suboptimal glycaemic control despite insulin therapy (HbA1c >9%) were initiated on add-on pioglitazone or metformin, and within-group changes in HbA1c and daily insulin requirement over 3 months were evaluated using paired t-tests.

The mean age at diagnosis was 42 ± 11.97 years, with a mean diagnostic delay of 2.83 ± 1.8 years. Only 10.5% of patients were correctly diagnosed with FCPD at initial presentation. Despite receiving insulin therapy, 76.5% of patients experienced progressive weight loss, and 76.8% reported frequent hypoglycaemic episodes.

FCPD in North Karnataka demonstrated atypical clinical features (low BMI and chronic diarrhoea) with delayed diagnosis and frequent hypoglycaemia. Glycaemic control could be optimised with short-acting insulin. Pioglitazone compared with metformin significantly improved glycaemic parameters and reduced insulin requirement, due to its effect on hepatic insulin resistance.