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Pancreatology. 2011 Jul 9;11 (3):279-294 21757968
Pancreatogenic Diabetes: Special Considerations for Management.
Yunfeng Cui, Dana K Andersen
Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins
University School of Medicine, Baltimore, Md., USA.
Background/Aims: Pancreatogenic, or type 3c, diabetes (T3cDM) occurs due to
inherited or acquired pancreatic disease or resection. Although similar to
the more prevalent type 1 and type 2 diabetes, pancreatogenic diabetes has a
unique pattern of hormonal and metabolic characteristics and a high incidence
of pancreatic carcinoma in the majority of patients with T3cDM. Despite these
differences, no guidelines for therapy have been described. Methods:
Published studies on the prevalence, pathophysiology, and cancer associations
of T3cDM were reviewed. The recent studies on the protective role and
mechanism of metformin therapy as both an anti-diabetic and anti-neoplastic
agent were reviewed, and studies on the cancer risk of other anti-diabetic
drugs were surveyed. Results: T3cDM accounts for 5-10% of Western diabetic
populations and is associated with mild to severe disease. Hepatic insulin
resistance is characteristic of T3cDM and is caused by deficiencies of both
insulin and pancreatic polypeptide. 75% of T3cDM is due to chronic
pancreatitis, which carries a high risk for pancreatic carcinoma. Insulin and
insulin secretagogue treatment increases the risk of malignancy, whereas
metformin therapy reduces it. Pancreatic exocrine insufficiency associated
with T3cDM contributes to nutritional deficiencies and the development of
metabolic bone disease. Conclusions: Until consensus recommendations are
reached, the glycemic treatment of T3cDM should avoid insulin and insulin
secretagogues if possible. Metformin should be the first line of therapy, and
continued if insulin treatment must be added for adequate glucose control.
Pancreatic enzyme therapy should be added to prevent secondary nutritional
and metabolic complications. and IAP.
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