Fibrocalculous pancreatic diabetes

Abstract

Fibrocalculous pancreatic diabetes (FCPD) is a unique form of diabetes secondary to chronic pancreatitis seen in developing countries of the world associated with either overt protein-calorie malnutrition or, more likely, with deficiency of certain micronutrients. FCPD affects young individuals and runs an aggressive course to reach the endpoints of diabetes, pancreatic calculi and exocrine pancreatic dysfunction (steatorrhoea) in the majority of cases. There are characteristic features of FCPD radiologically, ultrasonographically, on endoscopic retrograde cholangiopancreatography and on histopathology which distinguish it from chronic pancreatitis of other aetiologies seen in temperate zones, e.g. alcoholic chronic pancreatitis. Although a secondary form of diabetes, specific diabetes-related complications like retinopathy and nephropathy do occur in FCPD. There appears to be a high risk of developing pancreatic carcinoma. Although the aetiology of FCPD is still unclear, the role of micronutrient (antioxidant) deficiency is emerging as a possible aetiological or predisposing factor. The contribution of genetic factors and environmental toxins, e.g. cyanogenic glycosides or other nutritional/toxic factors, merit further study. Studies on FCPD, a good model of a secondary form of diabetes, could lead to improved understanding of other primary forms of diabetes as well. If the underlying aetiological factors are identified, it may also be possible to prevent this type of diabetes.

Role of islet autoimmunity in the aetiology of different clinical subtypes of diabetes mellitus in young north Indians

“…Most investigators believe that FCPD results from β‐cell dysfunction secondary to exocrine pancreatic damage[1–3,6,7]. The present study confirms previous evidence that islet autoimmunity is rare in FCPD[10–18], with ICA and IA‐2 A being absent and GADA present in only two (7%) patients.…”

The double burden of malnutrition and cardiometabolic risk widens the gender and socio-economic health gap: a study among adults in Burkina Faso (West Africa)

“…These results also appear somewhat consistent with the clinical features (i.e. poverty, protein-energy malnutrition, generalised wasting, insulin resistance) of malnutrition-related diabetes or fibrocalculous pancreatic diabetes (43) mostly reported from South Asia (44) , but with still limited evidence in Sub-Saharan Africa (45) . This should be of particular concern, especially when we are aware that estimates by the International Diabetes Federation suggest the number of adults with diabetes in Sub-Saharan Africa will increase by 98 % from 12?1 million in 2010 to 23?9 million in 2030 (46) .…”

Precision medicine in type 2 diabetes

“…FCPD affects young individuals and aggressively progresses towards T2D and steatorrhoea in a majority of cases. The subsequent development of complications is similar to that seen in T2D .…”