Diabetes of the Exocrine Pancreas: Implications for Pharmacological Management

Abstract

Post-pancreatitis diabetes mellitus, pancreatic cancer-related diabetes, and cystic fibrosis-related diabetes are often underappreciated. As a result, a substantial proportion of people with these sub-types of diabetes receive antidiabetic medications that may be suboptimal, if not harmful, in the context of their underlying disease of the exocrine pancreas. The present article delineates both classical (biguanides, insulin, sulfonylureas, α-glucosidase inhibitors, thiazolidinediones, and meglitinides) and newer (glucagon-like peptide-1 receptor agonists, amylin analogs, dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors, D2 receptor agonists, bile acid sequestrants, and dual glucagon-like peptide-1 receptor and glucose-dependent insulinotropic polypeptide receptor co-agonists) therapies and provides recommendations for managing people with diabetes of the exocrine pancreas based on the most up-to-date clinical evidence. Also, several emerging directions (lipid-enriched pathways, Y4 receptor agonism, glucagon-like peptide-1 and glucagon receptor co-agonism) are presented with a view to informing the process of new drug discovery and development.

Fig. 1

Sub-types of DEP. The sub-types are arranged according to their frequency in the general population. DEP diabetes of the exocrine pancreas

Fig. 2

Concept map of pharmacological management of DEP. DEP diabetes of the exocrine pancreas, DPP-4 dipeptidyl peptidase-4, GIP glucose-dependent insulinotropic polypeptide, GLP-1 glucagon-like peptide-1, SGLT-2 sodium-glucose co-transporter-2, PP pancreatic polypeptide