Pancreatic diabetes: an Indian perspective

Tropical calcific pancreatitis (TCP) and fibrocalculous pancreatic diabetes (FCPD) are unique forms of non-alcoholic pancreatitis and diabetes found almost exclusively in the tropics. Such patients can be erroneously labelled as having type 1 diabetes. A diagnosis of FCPD has potential implications in treatment, prediction of disease progression and complications. There are several characteristic features including young age of onset, progressive disease, non-ketotic diabetes, pancreatic calculi on imaging and a high risk of pancreatic cancer. Hyperglycaemia is usually severe and requires insulin, although ketoacidosis is a rare occurrence. Long term follow-up is necessary as microvascular complications have been reported. Macrovascular complications are less common due to a multitude of factors. The aetiology of TCP/FCPD is not clear but potential mechanisms include malnutrition, cyanogen toxicity, genetic factors, oxidant stress and micronutrient deficiency.