Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline
. 2013 Jul-Aug;13(4):336-42.
doi: 10.1016/j.pan.2013.05.002. Epub 2013 May 17.

Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: recommendations from PancreasFest 2012

Michael R Rickels  1 , Melena Bellin, Frederico G S Toledo, R Paul Robertson, Dana K Andersen, Suresh T Chari, Randall Brand, Luca Frulloni, Michelle A Anderson, David C Whitcomb; PancreasFest Recommendation Conference Participants
Collaborators, Affiliations
Practice Guideline

Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: recommendations from PancreasFest 2012

Michael R Rickels et al. Pancreatology. 2013 Jul-Aug.

Abstract

Description: Diabetes and glucose intolerance are common complications of chronic pancreatitis, yet clinical guidance on their detection, classification, and management is lacking.

Methods: A working group reviewed the medical problems, diagnostic methods, and treatment options for chronic pancreatitis-associated diabetes for a consensus meeting at PancreasFest 2012.

Results: Guidance Statement 1.1: Diabetes mellitus is common in chronic pancreatitis. While any patient with chronic pancreatitis should be monitored for development of diabetes, those with long-standing duration of disease, prior partial pancreatectomy, and early onset of calcific disease may be at higher risk. Those patients developing diabetes mellitus are likely to have co-existing pancreatic exocrine insufficiency. Guidance Statement 1.2: Diabetes occurring secondary to chronic pancreatitis should be recognized as pancreatogenic diabetes (type 3c diabetes). Guidance Statement 2.1: The initial evaluation should include fasting glucose and HbA1c. These tests should be repeated annually. Impairment in either fasting glucose or HbA1c requires further evaluation. Guidance Statement 2.2: Impairment in either fasting glucose or HbA1c should be further evaluated by a standard 75 g oral glucose tolerance test. Guidance Statement 2.3: An absent pancreatic polypeptide response to mixed-nutrient ingestion is a specific indicator of type 3c diabetes. Guidance Statement 2.4: Assessment of pancreatic endocrine reserve, and importantly that of functional beta-cell mass, should be performed as part of the evaluation and follow-up for total pancreatectomy with islet autotransplantation (TPIAT). Guidance Statement 3: Patients with pancreatic diabetes shall be treated with specifically tailored medical nutrition and pharmacologic therapies.

Conclusions: Physicians should evaluate and treat glucose intolerance in patients with pancreatitis.

Keywords: Chronic pancreatitis; Diabetes mellitus; GLP-1; Glucose tolerance test; Incretin; Insulin; Pancreatic polypeptide; Pancreatogenic diabetes.

PubMed Disclaimer

Conflict of interest statement

Disclosure Statement: The authors have no relevant conflicts of interest related to this material.

References

    1. Cui Y, Andersen DK. Pancreatogenic diabetes: special considerations for management. Pancreatology : official journal of the International Association of Pancreatology. 2011;11(3):279–94. - PubMed
    1. American_Diabetes_Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012 Jan;35(Suppl 1):S64–71. - PMC - PubMed
    1. Ewald N, Bretzel RG. Diabetes mellitus secondary to pancreatic diseases (Type 3c) - Are we neglecting an important disease? European journal of internal medicine. 2013 Apr;24(3):203–6. - PubMed
    1. Ewald N, Kaufmann C, Raspe A, Kloer HU, Bretzel RG, Hardt PD. Prevalence of diabetes mellitus secondary to pancreatic diseases (type 3c) Diabetes/metabolism research and reviews. 2012 May;28(4):338–42. - PubMed
    1. Etemad B, Whitcomb DC. Chronic pancreatitis: Diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120:682–707. - PubMed

Publication types

MeSH terms