A paper authored by Jennifer Vonderau, MMS, PA-C, was recently accepted for publication by the Journal of the American Academy of PAs (JAAPA). Vonderau is a Clinical Assistant Professor in the division of Physician Assistant Studies, housed within the Department of Allied Health Sciences.
The paper, “Diabetes Mellitus Type 3c (Pancreatogenic Diabetes),” is a continuing medical education article for PAs that discusses a less common subtype of diabetes mellitus which is estimated to account for about 5-10% of patients with diabetes mellitus.
What is Diabetes Mellitus Type 3c?
Diabetes mellitus type 3c (T3cDM) is caused by destruction of the pancreatic islet cells due to a variety of etiologies, most commonly chronic pancreatitis, pancreatic cancer and cystic fibrosis. It is always associated with pancreatic exocrine insufficiency, which causes impaired digestion due to loss of production of pancreatic enzymes.
The diagnosis of T3cDM follows the same principals of diagnosis of diabetes mellitus type 1 and type 2 (T1DM and T2DM) but with additional criteria of:
- Pancreatic insufficiency
- Evidence of an abnormal pancreas on abdominal imaging
- Absence of antibodies associated with T1DM
The treatment is also unique, as patients with T3cDM require pancreatic enzyme replacement to optimize glycemic control and are nearly always reliant on insulin instead of oral anti-hyperglycemic agents. Patients with T3cDM have what’s termed “brittle” diabetes, because not only do they have pancreatic impairment of production of insulin, but they also have impaired production of glucagon, causing frequent hypoglycemia (low blood sugar) in addition to hyperglycemia (high blood sugar). Since hypoglycemia can cause an increase in morbidity and mortality for patients with diabetes, it is important to recognize this risk.
Impact of the Research: Education for Better Patient Care
According to Vonderau, this topic represents an important subtype of diabetes mellitus. The number of patients with diabetes mellitus is growing annually and is upwards of 500 million adults globally. Any fraction of patients with T3cDM still represents a significant number of people.
Chronic pancreatitis, the most common etiology, is also an underreported disease process that is commonly misdiagnosed. Identifying patients with pancreatic disease as a cause of diabetes mellitus, rather than an autoimmune process (as in T1DM) or peripheral insulin resistance (as in T2DM), helps to ensure accurate diagnosis, identify important treatment considerations, and discuss prognosis.
“I am fortunate to have worked and researched in the field of chronic pancreatitis and pancreatogenic diabetes due to my experience and mentorship with attending surgeon Dr. Chirag Desai. I helped to build and grow a chronic pancreatitis surgical program at UNC and have ongoing clinical involvement in the care of these patients,” said Vonderau. “I am also fortunate to have clinical relationships with incredible colleagues in gastroenterology and endocrinology who greatly improved my understanding of these topics. I have previously published manuscripts as a contributing author regarding chronic pancreatitis and pancreatic surgery, and I hope to continue to publish works regarding hepatobiliary disease processes and these patient populations.”
Vonderau looks forward to sharing the article upon its publication.