DIAGNOSIS OF ENDOCRINE DISEASE: Diagnosing and classifying diabetes in diseases of the exocrine pancreas

Abstract

Diabetes in the setting of diseases of the exocrine pancreas has long existed as a known, but underdiagnosed or misdiagnosed, disorder. It currently finds itself in a state of taxonomic dereliction and requires a long overdue refurbishment. Correct conceptualisation is a key precondition for knowledge development in this disorder. This article lays out the epistemiological foundation for diabetes of the exocrine pancreas (DEP) and presents a synthesis of the current interdisciplinary discourse on diagnosing and classifying DEP. The diagnosis of DEP is generally based on the most up-to-date biochemical criteria endorsed by the American Diabetes Association and European Association for the Study of Diabetes. The presence of exocrine pancreatic dysfunction is not considered a mandatory diagnostic criterion for DEP but is rather a significant risk factor for developing DEP. DEP principally comprises post-pancreatitis diabetes mellitus, pancreatic cancer-related diabetes, and cystic fibrosis-related diabetes, which are mutually exclusive with autoimmune diabetes and type 2 diabetes. Other exclusions and stipulations apply. The DEP criteria will be instrumental in aiding optimal design and conduct of clinical studies, uniform collection of health utilisation data, meaningful comparison of scientific findings across countries, and clear communication among stakeholders (healthcare providers, patients, health regulatory authorities, pharmaceutical industry).

Pancreatic and gut hormones as predictors of new-onset prediabetes after non-necrotising acute pancreatitis: a prospective longitudinal cohort study

“…The used thresholds were in line with the DEP criteria ( 19 ). Given that FPG > 5.6 mmol/L (100 mg/dL) at baseline might be due to stress hyperglycaemia ( 20 ), FPG at baseline was not taken into consideration in grouping the study participants.…”

“…(3) New-onset prediabetes after AP (NOPAP): individuals with HbA1c <39 mmol/mol at baseline, and FPG between 5.6-6.9 mmol/L (100-125 mg/dL) and/or HbA1c between 39-47 mmol/mol (5.7-6.4%) during follow-up were deemed to have NOPAP. The used thresholds were in line with the DEP criteria (19). Given that FPG >5.6mmol/L (100mg/dL) at baseline might be due to stress hyperglycaemia (20), FPG at baseline was not taken into consideration in grouping the study participants.…”

Dietary Fibre Intake in Type 2 and New-Onset Prediabetes/Diabetes after Acute Pancreatitis: A Nested Cross-Sectional Study

“…Participants were categorised into three non-overlapping groups based on their FPG and/or HbA1c levels at the time of the study, in line with the 'DEP criteria' [28]. Individuals with normoglycemia after acute pancreatitis (NAP) included participants with HbA1c < 5.7% (39 mmol/mol) and/or FPG < 100 mg/dL (5.6 mmol/L) at the time of the study.…”

The Potential Causes of Cystic Fibrosis-Related Diabetes

“…Chronic hyperglycemia contributes directly to an increased risk of vascular diseases, renal failure, blindness, amputation, and neuropathy as well as decreased life expectancy while severe hyperglycemia can lead to coma and death (11). While the most common forms of diabetes are type 1 (T1D) and type 2 diabetes (T2D), diabetes of the exocrine pancreas (DEP) is also getting recognition as an important cause of diabetes [reviewed in (12,13)]. In T1D, representing less than 10% of overall cases, the immune system attacks and destroys insulin-producing pancreatic b-cells (14); patients living with T1D are dependent on exogenous insulin injections to regulate glucose levels (14).…”