Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Pancreatology. 2011;11(3):279-94. doi: 10.1159/000329188. Epub 2011 Jul 9.
BACKGROUND/AIMS: Pancreatogenic, or type 3c, diabetes (T3cDM) occurs due to inherited or acquired pancreatic disease or resection. Although similar to the more prevalent type 1 and type 2 diabetes, pancreatogenic diabetes has a unique pattern of hormonal and metabolic characteristics and a high incidence of pancreatic carcinoma in the majority of patients with T3cDM. Despite these differences, no guidelines for therapy have been described.
Published studies on the prevalence, pathophysiology, and cancer associations of T3cDM were reviewed. The recent studies on the protective role and mechanism of metformin therapy as both an anti-diabetic and anti-neoplastic agent were reviewed, and studies on the cancer risk of other anti-diabetic drugs were surveyed.
T3cDM accounts for 5-10% of Western diabetic populations and is associated with mild to severe disease. Hepatic insulin resistance is characteristic of T3cDM and is caused by deficiencies of both insulin and pancreatic polypeptide. 75% of T3cDM is due to chronic pancreatitis, which carries a high risk for pancreatic carcinoma. Insulin and insulin secretagogue treatment increases the risk of malignancy, whereas metformin therapy reduces it. Pancreatic exocrine insufficiency associated with T3cDM contributes to nutritional deficiencies and the development of metabolic bone disease.
Until consensus recommendations are reached, the glycemic treatment of T3cDM should avoid insulin and insulin secretagogues if possible. Metformin should be the first line of therapy, and continued if insulin treatment must be added for adequate glucose control. Pancreatic enzyme therapy should be added to prevent secondary nutritional and metabolic complications. and IAP.
背景/目的：胰源性糖尿病（T3cDM）是由于遗传性或获得性胰腺疾病或切除术引起的。尽管与更为常见的 1 型和 2 型糖尿病相似，但胰源性糖尿病具有独特的激素和代谢特征模式，并且大多数 T3cDM 患者中存在胰腺癌的高发率。尽管存在这些差异，但尚未描述治疗指南。
回顾了关于 T3cDM 的患病率、病理生理学和癌症相关性的已发表研究。回顾了最近关于二甲双胍治疗作为抗糖尿病和抗肿瘤药物的保护作用和机制的研究，并调查了其他抗糖尿病药物的癌症风险研究。
T3cDM 占西方糖尿病人群的 5-10%，与轻度至重度疾病相关。肝胰岛素抵抗是 T3cDM 的特征，由胰岛素和胰多肽的缺乏引起。75%的 T3cDM 是由慢性胰腺炎引起的，慢性胰腺炎伴有胰腺癌的高风险。胰岛素和胰岛素分泌素治疗会增加恶性肿瘤的风险，而二甲双胍治疗则会降低风险。与 T3cDM 相关的胰腺外分泌不足会导致营养缺乏和代谢性骨病的发生。
在达成共识建议之前，如果可能的话，T3cDM 的血糖治疗应避免使用胰岛素和胰岛素分泌素。二甲双胍应作为一线治疗药物，如果必须添加胰岛素治疗以达到充分的血糖控制，则应继续使用。应添加胰酶治疗以预防继发性营养和代谢并发症。
