2.3 Differentiation Diagnosis of T3cDM from T1 DM ...
When it comes to the differentiation between T3cDM and T1DM or T2DM，several additional laboratory tests are needed.The presence of islet autoimmune markers（e.g.，against glutamine acid decarboxylase，insulin，or islet cell antigen）is associated with T1DM.And the finding of evidence of insulin resistance（e.g.increased insulin secretion measured by C-peptide levels or acanthosis nigricans）is usually consistent with T2DM.These results can be used to distinguish T3cDM from TIDM or T2DM（Sze et al.2014；Ewald and Bretzel 2013）.However，if ambiguity remains，an absence of pancreatic polypeptide（PP）response to mixed-nutrient ingestion can be adopted as a specific indicator of T3cDM.The consensus statement from Pancreas Fest 2012 also recommend that the mixed-nutrient ingestion using a 12 ounces of Boost® or equivalent can be standardized and administered with prescribed pancreatic enzymes（Rickels et al.2013）.The non-diabetic subjects are characterized by four to sixfold increase of PP levels，whereas，CP patients demonstrate less than a double of basal values which is also reduced in CP patients（Cui and Andersen 2011）.These features can distinguish T3cDM from TIDM in which PP levels can increase normally（Larsen et al.1988；Rabiee et al.2011），and from T2DM in which both basal and stimulated values of PP are elevated（Rickels et al.2013；Glaser et al.1988）.But some authors argue that the sensitivity is low by measuring pancreatic polypeptide level to diagnose CP（Meier and Giese 2015；Eddes et al.2001）.(https://www.daowen.com)