Fibrocalculous Pancreatic Diabetes

In tropical countries there is a form of nonalcoholic chronic pancreatitis characterized by pancreatic exocrine and endocrine insufficiency and associated with pancreatic calcification. This disease, tropical calcific pancreatitis, affects young individuals who are malnourished and present with abdominal pain, extreme emaciation characteristic of protein-energy malnutrition, glucose intolerance, and at a later stage diabetes. The diabetic stage of the illness is referred to as fibrocalcific pancreatic diabetes (FCPD). Several reports of FCPD have been reported from the tropical countries and many cases have been reported from the Indian subcontinent. The pathogenesis of the disease is still unclear and is attributed to various possible causes -malnutrition, cassava toxicity, oxidant stress due to micronutrient deficiency, genetic and environmental factors. Recently, a study showed the N34S variant of the SPINK1 trypsin inhibitor gene as a susceptibility gene for FCPD in the Indian subcontinent. Although by itself it is not sufficient to cause FCPD, it indicates the role of gene-environment interaction in the pathogenesis of diabetes.

Patients with FCPD are at risk of long-term diabetic complications and require insulin to control their hyperglycemia. Given the underlying problem of malnutrition they benefit from high calorie intake, especially the protein content. There is a need for further investigation into the roles of nutritional, environmental, and genetic factors to establish the etiopathogenesis of this illness.

See also: Diabetes Mellitus: Classification and Chemical Pathology; Dietary Management. Glucose: Metabolism and Maintenance of Blood Glucose Level. Obesity: Complications. World Health Organization.

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