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.