Fibrocalculous pancreatic diabetes

Abstract

Chronic Pancreatitis and the type of diabetes associated with it have been named as “Fibrocalcific Pancreatic Diabetes” (FCPD). Initially categorized by WHO in 1985 as a subtype of Malnutrition Related Diabetes Mellitus (MRDM), FCPD has subsequently been included as a disease of the exocrine pancreas under other specific forms of diabetes. Despite many years since its first description, the etiopathogenesis of FCPD remains obscure. While insulin secretion defects are definitely the crux of the problem, there is growing body of evidence to suggest that insulin resistance may play a key role in glucose metabolism in these individuals. Moreover, the role of free fatty acids, counter-regulatory hormones like glucagon and impact of hepatic and peripheral lipid distribution on the dynamics of insulin secretion remains to be explored. Other factors related to alterations in energy expenditure may compound the pathogenetic picture. In fact, not all people with Fibro calculous Pancreatitis will develop diabetes and a search for the exact triggers for hyperglycemia might provide the clue to this enigmatic disease pathophysiology.