Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Pediatric Endocrinology and Schulze Diabetes Institute, University of Minnesota Medical Center, Minneapolis, MN, USA.
Lancet Gastroenterol Hepatol. 2016 Nov;1(3):226-237. doi: 10.1016/S2468-1253(16)30106-6. Epub 2016 Oct 12.
Diabetes mellitus is a group of diseases defined by persistent hyperglycaemia. Type 2 diabetes, the most prevalent form, is characterised initially by impaired insulin sensitivity and subsequently by an inadequate compensatory insulin response. Diabetes can also develop as a direct consequence of other diseases, including diseases of the exocrine pancreas. Historically, diabetes due to diseases of the exocrine pancreas was described as pancreatogenic or pancreatogenous diabetes mellitus, but recent literature refers to it as type 3c diabetes. It is important to note that type 3c diabetes is not a single entity; it occurs because of a variety of exocrine pancreatic diseases with varying mechanisms of hyperglycaemia. The most commonly identified causes of type 3c diabetes are chronic pancreatitis, pancreatic ductal adenocarcinoma, haemochromatosis, cystic fibrosis, and previous pancreatic surgery. In this Review, we discuss the epidemiology, pathogenesis, and clinical relevance of type 3c diabetes secondary to chronic pancreatitis and pancreatic ductal adenocarcinoma, and highlight several important knowledge gaps.
糖尿病是一组以持续性高血糖为特征的疾病。2 型糖尿病是最常见的一种，其特征最初为胰岛素敏感性受损，随后出现代偿性胰岛素反应不足。糖尿病也可能是其他疾病的直接后果，包括外分泌胰腺疾病。从历史上看，由于外分泌胰腺疾病引起的糖尿病被描述为胰源性或胰原性糖尿病，但最近的文献将其称为 3c 型糖尿病。需要注意的是，3c 型糖尿病不是单一实体；它是由于多种外分泌胰腺疾病引起的，其高血糖的机制也各不相同。最常见的 3c 型糖尿病的病因包括慢性胰腺炎、胰腺导管腺癌、血色病、囊性纤维化和先前的胰腺手术。在这篇综述中，我们讨论了继发于慢性胰腺炎和胰腺导管腺癌的 3c 型糖尿病的流行病学、发病机制和临床相关性，并强调了几个重要的知识空白。
