PMID- 30151918
OWN - NLM
STAT- MEDLINE
DCOM- 20190730
LR  - 20190730
IS  - 1440-1746 (Electronic)
IS  - 0815-9319 (Linking)
VI  - 34
IP  - 2
DP  - 2019 Feb
TI  - Diabetes of the exocrine pancreas.
PG  - 346-354
LID - 10.1111/jgh.14451 [doi]
AB  - Diabetes of the exocrine pancreas (DEP) is a form of diabetes that occurs due to 
      pancreatic disease. It is far more common than has been previously considered, 
      with a recent study showing 1.8% of adults with new-onset diabetes should have 
      been classified as DEP. The majority is misdiagnosed as type 2 diabetes mellitus 
      (T2DM). Patients with DEP exhibit varying degrees of exocrine and endocrine 
      dysfunction. Damage to the islet of Langerhans effects the secretion of hormones 
      from the beta, alpha, and pancreatic polypeptide cells; the combination of low insulin, 
      glucagon, and pancreatic polypeptide contributes to rapid fluctuations in glucose 
      levels. This form of "brittle diabetes" may result in the poorer glycemic control 
      observed in patients with DEP, when compared with those with T2DM. Diabetes of 
      the exocrine pancreas has a different natural history to other forms of diabetes; 
      patients are more likely to require early insulin initiation compared with those 
      with T2DM. Therefore, individuals with DEP should be advised about the symptoms 
      of decompensated hyperglycemia, although they are less likely to develop 
      ketoacidosis. Clinicians should screen for DEP in patients with acute or chronic 
      pancreatitis, following pancreatic resection, or with co-existing cystic fibrosis 
      or hemochromatosis. Incident diabetes may herald the onset of pancreatic ductal 
      carcinoma in a small subset of patients. Once identified, patients with DEP can 
      benefit from specific lifestyle advice, pancreatic enzyme replacement therapy, 
      metformin treatment, appropriate insulin dosing, and monitoring. Further research 
      is needed to establish the ideal treatment regimens to provide optimal clinical 
      outcomes for this unique form of diabetes.
CI  - (c) 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & 
      Sons Australia, Ltd.
FAU - Wynne, Katie
AU  - Wynne K
AUID- ORCID: 0000-0002-7980-3337
AD  - Department of Diabetes and Endocrinology, John Hunter Hospital, Newcastle, New 
      South Wales, Australia.
AD  - University of Newcastle, Newcastle, New South Wales, Australia.
FAU - Devereaux, Benedict
AU  - Devereaux B
AD  - Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
AD  - University of Queensland, Brisbane, Queensland, Australia.
FAU - Dornhorst, Anne
AU  - Dornhorst A
AD  - Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
AD  - Imperial College London, London, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180925
PL  - Australia
TA  - J Gastroenterol Hepatol
JT  - Journal of gastroenterology and hepatology
JID - 8607909
RN  - 0 (Biomarkers)
RN  - 0 (Blood Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 59763-91-6 (Pancreatic Polypeptide)
RN  - 9007-92-5 (Glucagon)
MH  - Animals
MH  - Biomarkers/blood
MH  - Blood Glucose/drug effects/*metabolism
MH  - Diabetes Mellitus/blood/diagnosis/drug therapy/*epidemiology
MH  - Diagnosis, Differential
MH  - Glucagon/blood
MH  - Humans
MH  - Hypoglycemic Agents/therapeutic use
MH  - Insulin/*blood/therapeutic use
MH  - Pancreas, Exocrine/drug effects/*metabolism
MH  - Pancreatic Diseases/diagnosis/*epidemiology
MH  - Pancreatic Polypeptide/blood
MH  - Predictive Value of Tests
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - adenocarcinoma
OT  - cystic fibrosis
OT  - diabetes mellitus
OT  - hemachromatosis
OT  - pancreatitis
EDAT- 2018/08/29 06:00
MHDA- 2019/07/31 06:00
CRDT- 2018/08/29 06:00
PHST- 2018/07/04 00:00 [received]
PHST- 2018/07/31 00:00 [revised]
PHST- 2018/08/19 00:00 [accepted]
PHST- 2018/08/29 06:00 [pubmed]
PHST- 2019/07/31 06:00 [medline]
PHST- 2018/08/29 06:00 [entrez]
AID - 10.1111/jgh.14451 [doi]
PST - ppublish
SO  - J Gastroenterol Hepatol. 2019 Feb;34(2):346-354. doi: 10.1111/jgh.14451. Epub 
      2018 Sep 25.