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World J Diabetes. Aug 15, 2023; 14(8): 1212-1225
Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1212
Diabetes mellitus as a consequence of acute severe pancreatitis: Unraveling the mystery
Manish Manrai, Anupam K Singh, Chhagan Lal Birda, Jimil Shah, Aditya Dutta, Sanjay Kumar Bhadada, Rakesh Kochhar
Manish Manrai, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, Maharashtra, India
Anupam K Singh, Jimil Shah, Rakesh Kochhar, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Chhagan Lal Birda, Department of Gastroenterology, All India Institutes of Medical Sciences, Jodhpur 342001, India
Aditya Dutta, Department of Endocrinology, Max Hospital, New Delhi 110017, India
Sanjay Kumar Bhadada, Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Manrai M, Singh AK, Birda CL, and Shah J wrote the manuscript; Singh AK and Birda CL prepared the research data; Dutta A, Bhadada SK and Kochhar R contributed to the discussion; and all authors reviewed and approved the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rakesh Kochhar, MBBS, MD, Professor, Department of Gastro-enterology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, F-Block Ground Floor, Chandigarh 160012, India. dr_kochhar@hotmail.com
Received: March 28, 2023
Peer-review started: March 28, 2023
First decision: April 26, 2023
Revised: May 19, 2023
Accepted: July 6, 2023
Article in press: July 6, 2023
Published online: August 15, 2023
Abstract

The occurrence of diabetes mellitus (DM) in pancreatitis is being increasingly recognized lately. Diabetes can develop not only with chronic pancreatitis but even after the first episode of acute pancreatitis (AP). The incidence of diabetes after AP varies from 18% to 23% in 3 years and reaches up to 40% over 5 years. The exact pathogenesis of diabetes after AP is poorly understood and various mechanisms proposed include loss of islet cell mass, AP-induced autoimmunity, and alterations in the insulin incretin axis. Risk factors associated with increased risk of diabetes includes male sex, recurrent attacks of pancreatitis, presence of pancreatic exocrine insufficiency and level of pancreatitic necrosis. Diagnosis of post-pancreatitis DM (PPDM) is often excluded. Treatment includes a trial of oral antidiabetic drugs in mild diabetes. Often, insulin is required in uncontrolled diabetes. Given the lack of awareness of this metabolic disorder after AP, this review will evaluate current information on epidemiology, risk factors, diagnosis and management of PPDM and identify the knowledge gaps.

Keywords: Post-pancreatitis diabetes, Diabetes of exogenous pancreas, Endocrine insufficiency, Acute pancreatitis, Post-pancreatitis diabetes mellitus

Core Tip: Diabetes mellitus (DM) due to diseases of the exocrine pancreas, diabetes of exocrine pancreas (DEP), is a common but underrecognized clinical entity. Post-pancreatitis DM (PPDM), which develop after pancreatitis, is classified as a subtype of DEP. The PPDM can develop even after acute pancreatitis; it is termed as post-acute pancreatitis DM. It differs in pathogenesis and natural history from type 1 and type 2 DM. There is a loss of pancreatic endocrine tissue, fibrosis and a component of autoimmunity. Both insulin deficiency and resistance play a role in this process. There are a number of knowledge gaps in diagnostic criteria, natural history and treatment options of PPDM.