Pancreatic Endocrine Insufficiency

Type 3c diabetes mellitus（T3cDM），also described as pancreatogenic or pancreatogenous diabetes mellitus，refers to diabetes due to disease of the exocrine pancreas.It can be misclassified as T1DM，or more commonly，T2DM.But it is distinct from both.Up to 25%of patients with chronic pancreatitis-related T3cDM were reported to have‘brittle diabetes’with rapid swings in glucose（Duggan et al.2017）and most people may need insulin therapy.Compared with non-smokers，Smoking can accelerate the development of chronic pancreatitis（～5 years），leading to an increased risk of developing calcifications and endocrine insufficiency（Issa et al.2014）.Since T3cDM are completely different from normal diabetes mellitus and even more difficult to manage due to liable glucose control，routine testing of fasting glucose and HbAlc should be normalized in these patients.In addition to standardized diabetic medications，PERT can help maximize incretin secretion，which is known to protect and proliferate pancreatic beta cells，and early referral to an endocrine specialist is also urged（Gupte and Forsmark 2014）.Metformin is often the firstline drug in management of T3cDM，especially in patients who are not overtly malnourished and have mild hyperglycemia（Majumder and Chari 2016）.Recently，drugs targeting incretins such as GLP-1 agonists and inhibitors of the incretin-degrading enzyme，dipeptidyl peptidase-4（DPP-4），have been developed as new treatments for type 2 diabetes mellitus.However，given the uncertain efficacy against T3cDM，the Japanese Society of gastroenterology has proposed the use of these drugs only when the benefits of treatment are considered to surpass the risks.So does sodium/glucose cotransporter 2（SGLT2）inhibitors（Ito et al.2015）.(https://www.daowen.com)

In this chapter，we reviewed pharmacological measures for CP.As for CP patients，conservative treatment is still the basic therapeutic strategy.It involves patient education，life style change，nutrition adjustment，“pain relief ladder”and multi-directional approaches for pain management，judicious administration of PERT as well as satisfactory glucose level.