From the Guidelines
An uncommon cause of type 2 diabetes in a patient presenting with fatigue, abdominal pain, unintentional weight loss, and an HbA1c of 7.6% is type 3c diabetes, also known as pancreatogenic diabetes, which is often associated with pancreatic disease, such as chronic pancreatitis. This condition is characterized by the destruction of pancreatic islet cells, leading to insulin deficiency and diabetes. The symptoms presented, including abdominal pain and unintentional weight loss, are consistent with chronic pancreatitis, which can cause type 3c diabetes. According to a study published in the Proceedings of the Nutrition Society 1, type 3c diabetes is a distinct form of diabetes that is often misclassified as type 2 diabetes. The study highlights the importance of considering pancreatic disease as a potential cause of diabetes in patients with unexplained weight loss, abdominal pain, and new-onset diabetes. Further evaluation with abdominal imaging (CT scan or MRI) and pancreatic function tests may be necessary to confirm the diagnosis of type 3c diabetes. Early detection and management of type 3c diabetes are crucial to prevent complications and improve quality of life. It is essential to note that type 3c diabetes can be difficult to control, and management may require a multidisciplinary approach, including medical nutrition therapy, pancreatic enzyme replacement, and insulin therapy. In contrast to the other options, type 3c diabetes is a more plausible explanation for the patient's symptoms, given the association between pancreatic disease and diabetes. Therefore, type 3c diabetes should be considered as a potential cause of diabetes in this patient, and further evaluation and management should be tailored accordingly. Key points to consider in the management of type 3c diabetes include:
- Individualized medical nutrition therapy to manage malabsorption and nutrient deficiencies
- Pancreatic enzyme replacement to improve nutrient absorption
- Insulin therapy to control blood glucose levels
- Regular monitoring of blood glucose levels and adjustment of treatment as needed
- Consideration of other complications associated with chronic pancreatitis, such as osteoporosis and depression.
From the Research
Uncommon Cause of Type 2 Diabetes
- An uncommon cause of type 2 diabetes in a patient with symptoms of fatigue, abdominal pain, unintentional weight loss, and a hemoglobin A1c (HbA1c) level of 7.6 could be pancreatic cancer 2, 3.
- Studies have shown that pancreatic cancer can cause deterioration of diabetes control, characterized by pronounced increases in HbA1c, persistent elevation of HbA1c after treatment intensification, and concomitant weight loss 2.
- New-onset type 2 diabetes and elevated HbA1c levels have been associated with an increased risk of pancreatic cancer 3.
Symptoms and Associations
- Fatigue is a common symptom in patients with diabetes, and it can be related to various factors, including physiological, psychological, and lifestyle factors 4, 5.
- Abdominal pain can be a manifestation of diabetic ketoacidosis (DKA) and is associated with severe metabolic acidosis and a history of alcohol or cocaine abuse 6.
- Unintentional weight loss can be a symptom of various conditions, including pancreatic cancer, and can be associated with diabetes deterioration 2.
Diagnostic Considerations
- The presence of abdominal pain, unintentional weight loss, and elevated HbA1c levels in a patient with type 2 diabetes should prompt further investigation to rule out pancreatic cancer 2, 3.
- A thorough medical history, physical examination, and laboratory tests, including imaging studies, should be performed to determine the underlying cause of the patient's symptoms 2, 3.