Diagnosis and treatment of diabetes mellitus in chronic pancreatitis

Table 1 Current classification of diabetes mellitus

I	Type 1 Diabetes Mellitus (β-cell destruction, usually leading to absolute insulin deficiency)
	A: Immune mediated B: Idiopathic
II	Type 2 Diabetes Mellitus (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance)
III	Other Specific Types Of Diabetes Mellitus
	A: Genetic defects of β-cell function
	B: Genetic defects in insulin action
	C: Diseases of the exocrine pancreas
	1: Pancreatitis
	2: Trauma/pancreatectomy
	3: Neoplasia
	4: Cystic fibrosis
	5: Hemochromatosis
	6: Fibrocalculous pancreatopathy
	7: Others
	D: Endocrinopathies
	E: Drug- or chemical-induced
	F: Infections
	G: Uncommon forms of immune-mediated diabetes
	H: Other genetic syndromes sometimes associated with diabetes
IV	Gestational Diabetes Mellitus

Source: Ref. [4,5], with permission.

Table 2 Proposed diagnostic criteria for type 3c diabetes mellitus

Major criteria (must be present)

Presence of exocrine pancreatic insufficiency (monoclonal fecal elas tase-1 test or direct function tests)

Pathological pancreatic imaging (endoscopic ultrasound, MRI, CT)

Absence of type 1 diabetes mellitus associated autoimmune markers

Minor criteria

Absent pancreatic polypeptide secretion

Impaired incretin secretion (e.g., GLP-1)

No excessive insulin resistance (e.g., HOMA-IR)

Impaired beta cell function (e.g., HOMA-B, C-Peptide/glucose-ratio)

Low serum levels of lipid soluble vitamins (A, D, E and K)

MRI: Magnetic resonance imaging; CT: Computed tomography; GLP-1: Glucagon-like peptide-1; HOMA-IR: Homeostasis model assessment of insulin resistance; HOMA-B: Homeostasis model assessment of beta-cell.