Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1212
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
Processing time: 135 Days and 16.5 Hours
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.
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.