Pancreatic Endocrine Insufficiency

This review aims to consolidate the latest knowledge on type 3c diabetes mellitus (T3cDM) and its management and pancreatic endocrine insufficiency (PEI) as a sequela, primarily focusing on two etiologies: pancreatitis and pancreatectomy.

PEI is a consequence of pancreatogenic diabetes, a distinct type of diabetes mellitus also known as T3cDM. T3cDM develops secondary to diseases of the exocrine pancreas and has a unique pattern of metabolic and hormonal characteristics. Several exocrine pancreatic disorders and procedures including acute, relapsing, and chronic pancreatitis, pancreatic cancer, and pancreatectomy have been identified as underlying causes for the development of T3cDM.

Diagnosis of T3cDM is challenging as it is often misclassified as type 1 or type 2 DM due to overlapping clinical presentations. Management of T3cDM and the PEI sequela is likewise difficult due to the occurrence of several confounding metabolic dysfunctions and poor nutritional status. Treatment of pancreatic exocrine insufficiency is critical when managing patients with T3cDM.