Fibrocalculous pancreatic diabetes mellitus fcdp is a unique form of diabetes mellitus, which is secondary to chronic calcification of the pancreas in young nonalcoholic people and exclusively found in tropical countries. Diabetes in youth, type 1 diabetes, type 2 diabetes, childhood diabetes, monogenic diabetes, fibrocalculous pancreatic diabetes background the increasing prevalence of diabetes among adolescents and young adults below 20 years of age is, perhaps, the most worrisome aspect of the global epidemic of diabetes. Pancreatic diabetes, pancreatogenous diabetes, and tropical pancreatic diabetes. It is a complication of nonalcoholic chronic calcific pancreatitis and occurs in lean, young individuals with a male preponderance 1. Fibrocalculous pancreatopathy fcpp is a secondary form of diabetes mellitus of unresolved etiology that has historically been considered an issue specific to the impoverished agricultural tropics of india, but also occurs in the countries of bangladesh, china, and ethiopia see also. The association of malnutrition and diabetes was first documented by zuidema in 1959 from indonesia. Dna sequencing conrms the absence of the three kindred with hereditary pancreatitis conrms mapping of the known trypsinogen gene mutations. Apr 30, 2015 fibrocalculous pancreatic diabetes is a unique entity wherein pancreatic calcification and chronic inflammation lead to exocrine and endocrine failure of the pancreas. Fibrocalculous pancreatic diabetes in a young ugandan. Prevalence of diabetes mellitus secondary to pancreatic diseases type 3c. Insulin deficiency plays a major role in the etiopathogenesis of fcpd. A more extensive investigation of patients with pancreatic diseases. Diabetes is now becoming a major cause of morbidity and mortality in both developing and developed countries.
Type 3c diabetes is frequently misclassified, mostly as type 2 diabetes1. The hallmarks of the disease are the occurrence of abdominal pain since childhood and pancreatic calculi associated with dilatation of the pancreatic. Fibrocalculous pancreatic diabetes fcpd is seen mainly in young and malnourished individuals belonging to tropical and developing countries. Background diabetes is now becoming a major cause of morbidity and mortality in both developing and developed countries. Fcpd is one of the two forms of malnutrition related diabetes mellitus mrdm, the other type. Fibrocalculous pancreatic diabetes fcpd is a secondary cause of diabetes due to chronic pancreatitis. A comparative study of the clinical profile of fibrocalculous. Spink1psti mutations are associated with tropical pancreatitis. Genetic susceptibility to fibrocalculous pancreatic. Challenges in diagnosis and management of diabetes in the young. Tropical calcific pancreatitis tcp is a juvenile form of chronic calcific, non alcoholic pancreatitis highly prevalent in developing and tropical countries.
Fibrocalculous pancreatic diabetes in a patient residing in. Research design and methods fecal chymotrypsin fct and fasting cpeptide levels were measured in 20 consecutive patients with fcpd and 19 with pdpd. Fibrocalculous pancreatic diabetes fcpd is an uncommon form of diabetes that occurs as a result of chronic calcific pancreatitis, in the absence of alcohol abuse. Pddm is distinguished from iddm in that despite severe insulin requiring diabetes, patients do not develop ketosis if insulin injections are withdrawn. To determine the prevalence of diabetes related complications in subjects with fibrocalculous pancreatic diabetes fcpd and compare them with subjects with type 2 diabetes mellitus matched for age, sex, and duration of diabetes. Sep 01, 2004 read prevalence of diabetic complications in fibrocalculous pancreatic diabetic patients and type 2 diabetic patients, journal of diabetes and its complications on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Acute pancreatitis associated with type 2 diabetes is usually due to gallstones.
A diagnosis is made basing on the presence of abdominal pain, presence of pancreatic calcifications, steatorrhoea, and diabetes mellitus. The classical triad of tcp consists of abdominal pain, steatorrhoea, and diabetes. Pathologic anatomy of pancreas in juvenile diabetes mellitus. Fibrocalculous pancreatic diabetes fcpd and protein deficient diabetes mellitus pddm. There is no population based data on prevalence of fibrocalculous pancreatic diabetes.
Fcpd is a type of diabetes secondary to a unique form of chronic pancreatitis seen in developing countries. The genetic predisposition to fibrocalculous pancreatic. Fibrocalculous pancreatic diabetes is an infrequent type of secondary diabetes due to chronic tropical non alcoholic calcific pancreatitis. In the current classification, type 3 dm includes diabetes due to various secondary causes, and dm secondary to pancreatic exocrine dysfunction is placed in the type 3c subcategory.
Fibrocalculous pancreatic diabetes fcpd is a rare form of diabetes secondary to chronic calcific pancreatitis. Objective this paper reports on prevalence of fibrocalculous pancreatic diabetes in chennai in south india based on the chennai urban rural epidemiology study. Even though type 1 and type 2 are the commonest, diabetes mellitus due to secondary causes have been identified. All the cgmderived measures of gv sd, mage, conga, modd, and %cv, except m value, were significantly higher in the fcpd group than in the t2d group p 180, auc 180, hbgi, and j index were significantly higher in the fcpd group than in the t2d group p apr 30, 2015 diabetes is now becoming a major cause of morbidity and mortality in both developing and developed countries. Exocrine pancreatic function serum immunoreactive trypsin, fecal chymotrypsin, and pancreatic isoamylase in indian diabetics. However, the association of acute pancreatitis with type 1 diabetes mellitus is uncommon. When diabetes is present, the condition is called fibrocalculous pancreatic diabetes fcpd which is thus a later stage of tcp. The diagnosis and management of diabetes in youth presents several unique challenges. Although type 1 diabetes is more common among children and adolescents, the incidence of type 2 diabetes in youth is also on the rise. Nov 14, 2014 fibrocalculous pancreatic diabetes fcpd is an uncommon form of diabetes that occurs as a result of chronic calcific pancreatitis, in the absence of alcohol abuse. In a preliminary study, we found serine protease inhibitor, kazal type 1 spink1 mutations in 6 of 8 patients with fibrocalculous pancreatic diabetes in bangladesh. Pdf pancreatitis in fibrocalculous pancreatic diabetes.
Fibrocalculous pancreatic diabetes fcpd is a form of type 3c pancreatogenic diabetes mellitus predominantly seen in the developing tropical countries. Fibrocalculous pancreatic diabetes in a young ugandan patient. In addition to the classical type 1 and type 2 forms of diabetes, other rare forms of diabetes mellitus dm like fibrocalculous pancreatic diabetes fpd have been described and still exist in ssa. The prevalence of diabetes in children and adolescents is increasing worldwide, with profound implications on the longterm health of individuals, societies, and nations. It is associated with an increased risk of pancreatic carcinoma. Studies have looked at the prevalence of diabetes in pancreatic diseases and pancreatic diseases in diabetes ewald et al 2012, woodmansey et al 2017 and pendharker et al 2017 type 3c diabetes accounts for 19% of all diabetes 45% reasonable estimate type 3c diabetes frequently misdiagnosed as type 2 diabetes. Tropical chronic pancreatitis postgraduate medical journal. Fibrocalculous pancreatic diabetes fcpd is a secondary form of diabetes seen in patients with tropical chronic pancreatitis. Tropical chronic pancreatitis tcp is a juvenile form of chronic calcific nonalcoholic pancreatitis, seen almost exclusively in the developing countries of the tropical world. Four patients with fcpd who were obese are reported in this paper and this is the first report of obesity in fcpd patients.
To determine the prevalence of diabetesrelated complications in subjects with fibrocalculous pancreatic diabetes fcpd and compare them with subjects with type 2 diabetes mellitus matched for age, sex, and duration of diabetes. Genetic susceptibility to fibrocalculous pancreatic diabetes. Prevalence of diabetic complications in fibrocalculous. Comparison of cgmderived measures of glycemic variability. A lot of patients, in our dataset it was 42%, went from type 2 diabetes to uncontrolled type 2 diabetes, which seems like a really high percentage of people developing uncontrolled type 2 diabetes. Fibrocalculous pancreatic diabetes is a unique entity wherein pancreatic calcification and chronic inflammation lead to exocrine and endocrine failure of the pancreas.
This german study showed that, using the ada classification, in a sample of nearly 1,922 people with diabetes, 8 per cent had type 3c. Nov 10, 2016 the prevalence of diabetes in children and adolescents is increasing worldwide, with profound implications on the longterm health of individuals, societies, and nations. Fibrocalculous pancreatic diabetes fcpd springerlink. We described the existence of this entity in the subtropical regionthe kashmir valley of the indian subcontinent and compared the clinical characteristics of these patients with type 2 diabetes. Fibrocalculous pancreatic diabetes fcpd is an uncommon cause of diabetes, seen mainly in developing countries.
The patients generally have clinical triad of pain abdomen, steatorrhoea and diabetes. Even some drugs used in management of diabetes can cause pancreatitis. When the investigations do not point towards an obvious cause, it is termed as idiopathic pancreatitis. Aug 08, 2016 a lot of patients, in our dataset it was 42%, went from type 2 diabetes to uncontrolled type 2 diabetes, which seems like a really high percentage of people developing uncontrolled type 2 diabetes. Assessment of insulin sensitivity and secretion in. The aetiology of fibrocalculous pancreatic diabetes is thought to be environmental although the agents is unknown. Tropical pancreatitis, including tropical calcific pancreatitis and fibrocalculous pancreatic diabetes, is endemic in parts of asia and africa. To compare glycemic variability gv indices between patients with fibrocalculous pancreatic diabetes fcpd and type 2 diabetes mellitus t2d using continuous glucose monitoring cgm. Here, we present a case of a type 1 diabetic patient who developed acute pancreatitis.
The clinical spectrum of fibrocalculous pancreatic diabetes. Fibrocalculous pancreatopathy fcpp is a secondary form of diabetes mellitus of unresolved etiology that has historically been considered an issue specific to the impoverished agricultural tropics of india, but also occurs in the countries of bangladesh, china, and ethiopia. This form of nonalcoholic pancreatopathy is exclusively seen among the young, with a male preponderance and commonly in tropical countries where malnutrition and poverty go hand. Spink1 is a susceptibility gene for fibrocalculous pancreatic. Prevalence of fibrocalculous pancreatic diabetes in. Since the n34s variant of the spink1 trypsin inhibitor gene has been found to partially account for genetic susceptibility to chronic pancreatitis, we used a familybased and casecontrol approach in two separate ethnic groups from the indian subcontinent, to determine whether n34s was.
Assessment of insulin sensitivity and secretion in patients. The genetic predisposition to fibrocalculous pancreatic diabetes. It has been widely described exclusively in developing tropical countries. Fibrocalculous pancreatic diabetes fcpd is a form of diabetes secondary to chronic pancreatitis that is found in tropical countries. Fcpd, pancreatic diseases fibrocalculous pancreatic diabetes a rare form of dm caused by chronic tropical pancreatitis and destruction of insulinproducing islet cells. Mohan v, snehalatha c, ahmed mr, et al, 1989 exocrine pancreatic function in tropical fibrocalculous pancreatic diabetes.
Challenges in diagnosis and management of diabetes in the. The disease is restricted to tropical regions of the world, and southern india has the highest known prevalence of fcpd. We have investigated a possible genetic basis of this disease by looking for restriction fragment length. Both acute pancreatitis and chronic pancreatitis are associated with the type 2 diabetes. Hassan z, mohan v, ali l et al, spink1 is a susceptibility gene for fibrocalculous. A familybased study was carried out in 67 bangladeshi families, consisting of a. Fibrocalculous pancreatic diabetes fcpd request pdf. Fcpd, pancreatic diseases fibrocalculous pancreatic diabetes a rare form of dm caused by chronic tropical pancreatitis and. Describing the data they used, xiu outlines their approach and methodology as well. The usual causes are alcoholic chronic pancreatitis in the west and tropical chronic pancreatitis in tropical countries like india. Spink1 is a susceptibility gene for fibrocalculous. Context fibrocalculous pancreatic diabetes is a form of diabetes secondary to chronic pancreatitis found in tropical, developing countries. This case report demonstrates a rare form of secondary diabetes in a middle aged female, without a childhood history of abdominal pain suggestive of pancreatitis, indicating late onset disease.
Fibrocalculous pancreatic diabetes previously known as tropical pancreatic diabetes is a rare cause of diabetes confined to countries within the tropical belt. Results the prevalence of fibrocalculous pancreatic diabetes is 0. Most patients with fcpd are lean and many are frankly undernourished. Association of acute pancreatitis in a patient with type 1. Prevalence of fibrocalculous pancreatic diabetes in chennai. A diagnosis is made basing on the presence of abdominal pain, presence of pancreatic calcifications, steatorrhoea, and diabetes. The typical patient with fcpd is a lean adolescent or young adult of either sex, presenting with history of. Fibrocalculous pancreatic diabetes in a patient residing. Fibrocalculous pancreatic diabetes fcpd is a secondary form of diabetes, described from several tropical countries, including india. Fibrocalculous pancreatic diabetes fcpd symptoms, causes, diagnosis, and treatment information for fibrocalculous pancreatic diabetes fcpd malnutritionrelated diabetes mellitus with alternative diagnoses, fulltext book chapters, misdiagnosis, research treatments, prevention, and prognosis. Read prevalence of diabetic complications in fibrocalculous pancreatic diabetic patients and type 2 diabetic patients, journal of diabetes and its complications on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Fibrocalculous pancreatic diabetes and obesity mayo clinic.