Chronic pancreatitis, pancreatic cancer and other pancreatic disorders can cause diabetes that may be insulin dependent. ‘Pancreatogenic’ diabetes underlies 2 to 10% of diabetes cases and has specific management implications, but is frequently misdiagnosed.
- Diabetes caused by pancreatic disease accounts for 2 to 10% of diabetes cases, and may be more common than type 1 diabetes.
- The most common underlying cause is acute or chronic pancreatitis. Other causes include pancreatic cancer, surgical pancreatectomy, haemochromatosis and cystic fibrosis.
- Clinical features that may raise suspicion for underlying pancreatic disease in a patient with diabetes include low/normal body weight or weight loss, negative type 1 diabetes antibodies and low serum C-peptide levels. Further tests such as faecal elastase level and abdominal imaging may assist diagnosis.
- Insulin is the best treatment. Patients may also benefit from pancreatic enzyme and fat-soluble vitamin supplementation.