Type 3c

Abstract

islets of Langerhans, leading to poor glycemic control. This type has a different cause, pathophysiology, clinical presentation, diagnostic assessment, treatment, and prognosis compared with types 1 and 2 diabetes, but commonly is misdiagnosed as type 2 diabetes. 3 Type 3c often is called brittle diabetes, because glucose control is especially challenging absent an appropriate beta cell (insulin) or alpha cell (glucagon) response. 4 Patients with type 3c diabetes are more likely to experience complications and death related to hypoglycemic events, and recognition of type 3c diabetes is critical for appropriate patient care and long-term management. 4,5 In Western populations, type 3c diabetes is estimated to occur in 5% to 10% of all patients with diabetes; however, the true prevalence is relatively unknown, and type 3c diabetes is routinely misclassifi ed or misdiagnosed. 4,6 Considering the frequency with which diabetes is diagnosed in clinical practice, recognition and adequate treatment of type 3c diabetes are paramount to optimal patient care. PATHOPHYSIOLOGYThe pancreas is a retroperitoneal organ with borders adjacent to the duodenum, vena cava, aorta, and spleen. Its structure comprises the pancreatic parenchyma (head, neck, body, and tail) and the pancreatic duct. The pancreas has exocrine and endocrine functions. The acinar cells produce pancreatic enzymes that aid in digestion. Pancre-© ANDREA DANTI/SHUTTERSTOCK.COM D iabetes, a group of diseases defi ned by persistent and recurrent hyperglycemia, affects more than 500 million adults worldwide. 1 The American Diabetes Association (ADA) defi nes several types of diabetes, all caused by a defi ciency of production or function of insulin (or both). 2 In type 3c diabetes (also known as pancreatogenic diabetes), primary pancreatic disorders damage the pancreatic ABSTRACT Type 3c diabetes, also known as pancreatogenic diabetes, occurs when primary pancreatic disorders damage the pancreatic islets of Langerhans. Although often misdiagnosed as type 2 diabetes, type 3c diabetes is different in cause, clinical presentation, treatment, and prognosis. Patients with type 3c diabetes are more likely to experience complications and death related to hypoglycemic events. This article reviews the causes and management of type 3c diabetes, which is estimated to affect 5% to 10% of all patients with diabetes.

The Cause and Effect Relationship of Diabetes after Acute Pancreatitis

“…Type 3c is often called brittle diabetes because glucose control is especially challenging absent an appropriate beta cell (insulin) or alpha cell (glucagon) response. Patients with type 3c diabetes are more likely to experience complications and death related to hypoglycemic events [ 36 ].…”

“…T3cDM is associated with an incidence ranging from 25% to 80% with chronic pancreatitis [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. The risk of diabetes in patients with chronic pancreatitis increases with the duration of the disease and with the severity of damage to the pancreas, especially in the early form of pancreatic calcifications.…”

“…Several studies have also been published on the prevention and treatment of newly diagnosed diabetes after AP, but risk factors remain controversial [ 3 , 9 , 45 ]. Therefore, a mechanism of T3cDM has been proposed, including inflammation, fibrosis, and hardening of the endocrine tissue of the pancreas, which leads to a gradual reduction and loss of β-cell function, leading to impaired or non-insulin secretion [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] ( Figure 3 ).…”

“…In general, there is no evidence-based treatment for type 3c diabetes, which is uniquely different from type 1 and type 2 diabetes, and treatment should be based on cause and pathophysiology [ 36 ]. Treatment of type 3c diabetes mellitus should include treatment of endocrine and exocrine pancreatic insufficiency.…”

A novel clinical model for risk prediction and stratification of new-onset diabetes mellitus after distal pancreatectomy

“…Decreased insulin, glucagon, and pancreatic polypeptide serum levels can lead to fluctuation in the blood glucose levels of these patients (4). Thus, hypoglycemia is more common in T3cDM, referred to as 'brittle diabetes', and requires strict insulin administration (5)(6)(7).…”