SMART Medical Review Type 3c Diabetes: Bridging the Diagnostic and Therapeutic Gap in Pancreatogenic Diabetes

Type 3c diabetes mellitus (T3cDM), also known as pancreatogenic diabetes, arises from diseases affecting the exocrine pancreas and is frequently misclassified as type 1 or type 2 diabetes mellitus. Despite accounting for an estimated 5–10% of diabetes cases in Western populations, T3cDM remains underrecognized in clinical practice. It encompasses a heterogeneous group of conditions, including chronic pancreatitis, pancreatic cancer, cystic fibrosis, and pancreatic surgery, each with distinct implications for metabolic and nutritional management. The clinical presentation of T3cDM often involves both insulin deficiency and exocrine pancreatic insufficiency, leading to complex challenges in glycemic control and increased risk for micronutrient deficiencies. Misclassification can result in inappropriate treatment strategies and poorer outcomes. Recognizing the unique pathophysiology of T3cDM is essential for tailoring therapy that addresses both endocrine and exocrine dysfunction. Early diagnosis and a multidisciplinary approach are critical to optimize glucose management, nutritional status, and long-term health outcomes in this population. Greater awareness and clearer diagnostic criteria are needed to ensure patients with T3cDM receive timely and appropriate care.