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Fibrocalculous pancreatic diabetes (FCPD)

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Abstract

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. The disease is restricted to tropical regions of the world, and southern India has the highest known prevalence of FCPD. The typical patient with FCPD is a lean adolescent or young adult of either sex, presenting with history of recurrent bouts of abdominal pain and steatorrhea. Demonstration of large, discrete pancreatic calculi by plain radiographs or ultrasonography of the abdomen is diagnostic. While the exact etiology of FCPD is unknown, genetic, nutritional and inflammatory factors have been hypothesized to play a role. Diabetes in FCPD is often brittle and difficult to control; most patients require multiple doses of insulin for control of glycemia. However, in spite of high blood glucose levels, patients rarely develop ketosis. Malabsorption responds to pancreatic enzyme supplementation. Surgical removal of stones is indicated for symptomatic relief of intractable pain. While patients with FCPD develop microvascular complications as frequently as those with type 2 diabetes, macrovascular disease is uncommon. Development of pancreatic malignancy is the most dreaded complication and should be suspected in any patient who complains of weight loss, back pain or jaundice.

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Ranjit Unnikrishnan and Viswanathan Mohan declare that they have no conflict of interest.

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  1. Dr. Mohan’s Diabetes Specialities Centre, Madras Diabetes Research Foundation, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India

    Ranjit Unnikrishnan & Viswanathan Mohan

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Correspondence to Viswanathan Mohan.

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Unnikrishnan, R., Mohan, V. Fibrocalculous pancreatic diabetes (FCPD). Acta Diabetol 52, 1–9 (2015). https://doi.org/10.1007/s00592-014-0685-9

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