|
TABLE 5 . Clinical Features of DM2 and DM3c |
|
Clinical Factors |
DM2 |
DM3c |
microvascular disease ( retinopathy ) 3
|
Risk is present |
Risk is present at a higher degrees , equivalent to DM1 |
timing of insulin required 3
|
Later in the disease course |
Rarely in the disease course |
dose of insulin required 3
|
May be required |
Often required at markedly higher doses |
HgA1c at presentation 3
|
Elevated |
Elevated more than DM2 |
glycemic control 3
|
Poor glycemic control is a risk |
Greater likelihood of poor glycemic control |
glucose level 4
|
Stable , slightly fluctuation |
Can be brittle with large swings |
malnutrition 4
|
No |
May be present |
steatorrhea 4
|
No |
May be present |
DMI : diabetes mellitus type 1 , DM2 : diabetes mellitus type 2 , DM3c : diabetes mellitus type 3c |
* Superscripts correspond to respective references . |
CONCLUSION
Diabetes mellitus is a critical health issue in WV . In 2017 , WV had the highest rate of DM in the nation at 15.2 % of the population , as compared to the national average of 9.4 %. 5 Further , DM and chronic pancreatitis are closely linked in that 26-80 % of diabetic patients experience chronic pancreatitis . 4 As this case illustrates , a diagnosis of type 3c diabetes should be considered in any patient with hyperglycemia and underlying pancreatic disease . Despite receiving more attention in recent years , this diagnosis remains misunderstood and overlooked by clinicians . While type 3c diabetes impacts a relatively small proportion of all DM cases , it has serious implications for West Virginians .
TABLE 6 . Treatment Recommendations for DM2 and DM3c Treatment DM2 DM3c
glucagon-like peptide 1 receptor agonists (“ incretins ”) 1 , 3
Yes
Contraindicated due to increased risk of pancreatitis and pancreatic ductal adenocarcinoma
dipeptidyl peptidase 4 |
Yes |
Contraindicated due to increased risk of |
inhibitors (“ gliptins ”) 1 , 3
|
|
pancreatitis and pancreatic ductal adenocarcinoma |
PERT ( pancreatic enzyme |
No |
Yes |
replacement therapy ) 1 , 3
|
|
|
insulin 4 Yes Preferred
metformin |
Yes |
Recommended if glucose elevation is mild and |
hydrochloride 4
|
|
concomitant insulin resistance is suspected |
thiazolidinedione 4 Yes Avoid use due increased risk of osteoporosis sulfonureas 4 Yes Yes DMI : diabetes mellitus type 1 , DM2 : diabetes mellitus type 2 , DM3c : diabetes mellitus type 3c * Superscripts correspond to respective references .
REFERENCES
1 . Hart PA , Bellin MD , Anderson DK , et al . Type 3c ( pancreatogenic ) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer . Lancet Gastroenterol Hepatol . 2016 ; 1 ( 3 ): 226-237 .
2 . Ewald N , Hardt PD . Diagnosis and treatment of diabetes mellitus in chronic pancreatitis . World Journal of Gastroenterology . 2013 ; 19 ( 42 ); 7276- 7281 .
3 . Woodmansey C , McGovern AP , McCullough KA , et al . Incidence , demographics , and clinical characteristics of diabetes of the exocrine pancreas ( Type 3c ): a retrospective cohort study . Diabetes Care . 2017 ; 40:1486-1493 .
4 . Rickels MR , Bellin M , Toledo F , et al . Detection , evaluation and treatments of diabetes mellitus in chronic pancreatitis : recommendations from PancreasFest 2012 . Pancreatology . 2013 ; 13:336-342 .
5 . Centers for Disease Control and Prevention ( CDC ). Behavioral Risk Factor Surveillance System Survey Data . Atlanta , Georgia : U . S .
Department of Health and Human Services , Centers for Disease Control and Prevention , 2017 .
6 . WV Health Statistics Center . West Virginia Behavioral Risk Factor Surveillance Report , 2014 .
West Virginia Medical Journal • June 2021 • 39