Diabetes After Pancreatitis: Timing, Mechanisms, and Early Intervention Strategies

Acute pancreatitis (AP) and chronic pancreatitis (CP) are increasingly recognised as important contributors to the development of diabetes secondary to pancreatic disease, commonly referred to as Type 3c diabetes mellitus (T3cDM). Although diabetes following pancreatitis has long been considered an uncommon consequence of severe pancreatic injury, growing epidemiological and translational evidence indicates that it is a frequent, underdiagnosed, and clinically distinct form of diabetes associated with significant metabolic and pancreatic complications.Recent studies suggest that 15–25% of patients develop diabetes within 3–5 years of an episode of acute pancreatitis, with the risk rising further after recurrent acute pancreatitis, chronic pancreatitis, pancreatic necrosis, or pancreatic surgery. Unlike type 1 and type 2 diabetes, PPDM arises from a complex interplay of endocrine cell loss, persistent inflammation, fibrosis, immune dysregulation, gut microbiome alterations, and impaired incretin signalling. Patients with PPDM often experience poorer glycaemic control, higher insulin requirements, and an increased risk of pancreatic exocrine insufficiency, malnutrition, cardiovascular disease, and pancreatic cancer.Despite its growing clinical importance, significant gaps remain in understanding the timing of diabetes onset, identifying high-risk individuals, detecting early biomarkers, elucidating underlying molecular mechanisms, and developing evidence-based intervention strategies. Early diagnosis offers an opportunity to prevent irreversible endocrine dysfunction and improve long-term metabolic outcomes.This Special Issue aims to provide a comprehensive platform for clinicians, endocrinologists, gastroenterologists, pancreatologists, surgeons, epidemiologists, and basic scientists to present cutting-edge research on the pathogenesis, diagnosis, prevention, and management of post-pancreatitis diabetes.We welcome original research, systematic reviews, meta-analyses, clinical trials, translational studies, and expert perspectives addressing the evolving landscape of post-pancreatitis diabetes.Aim of the Special IssueThis Special Issue aims to advance understanding of diabetes that develops after pancreatitis by integrating clinical, translational, and experimental research. It emphasises early detection, mechanistic insights, biomarker discovery, risk stratification, and therapeutic interventions that may prevent or delay progression to permanent pancreatic endocrine dysfunction.Scope and Topics of InterestWe invite submissions covering, but not limited to, the following themes:· Epidemiology and Natural History· Incidence and prevalence of diabetes after acute and chronic pancreatitis.· Timing of diabetes onset following the first episode of pancreatitis.· Risk prediction following recurrent acute pancreatitis.· Global burden and population-based studies of PPDM.· Pathophysiological Mechanisms· Beta-cell injury and endocrine pancreatic dysfunction.· Pancreatic inflammation and fibrosis.· Immune-mediated mechanisms and cytokine signaling.· Oxidative stress, mitochondrial dysfunction, and apoptosis.· Efferocytosis and inflammatory resolution in pancreatic injury.· Islet–acinar crosstalk during pancreatic regeneration.· Biomarkers for Early Diagnosis· Blood-based biomarkers.· Inflammatory and metabolic biomarkers.· C-peptide, insulin, glucagon, pancreatic polypeptide, and incretins.· Multi-omics biomarkers (genomics, proteomics, metabolomics).· Circulating extracellular vesicles and microRNAs.· AI-driven biomarker discovery.· Imaging and Functional Assessment· MRI, CT, EUS, elastography, and PET imaging.· Imaging biomarkers predicting endocrine dysfunction.· Assessment of pancreatic exocrine insufficiency.· Functional pancreatic reserve testing.· Gut Microbiome and Metabolic Regulation· Microbiome alterations after pancreatitis.· Gut–pancreas axis.· Microbial metabolites and glucose metabolism.· Microbiome-targeted interventions.· Animal Models and Translational Research· Experimental models of acute and chronic pancreatitis.· Models of pancreatogenic diabetes.· Large and small animal models.· Regenerative medicine and pancreatic repair.· Stem-cell and organoid models.· Prevention and Early Intervention· Lifestyle interventions after pancreatitis.· Nutritional management.· Pancreatic enzyme replacement therapy and glucose metabolism.· Anti-inflammatory therapies.· GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors, and insulin strategies.· Precision medicine approaches.· Differential Diagnosis of Type 3c Diabetes· Distinguishing PPDM from Type 1 and Type 2 diabetes.· Diagnostic criteria and screening algorithms.· Clinical phenotyping.· Role of pancreatic exocrine function tests.· Diabetes and Pancreatic Cancer· New-onset diabetes after pancreatitis as an early warning sign.· Diabetes as a biomarker for pancreatic cancer.· Shared inflammatory and molecular pathways.· Screening strategies for high-risk populations.· Clinical Management and Long-Term Outcomes· Glycemic management in pancreatitis survivors.· Complications and cardiovascular outcomes.· Quality of life.· Personalized follow-up strategies.· Clinical practice guidelines and consensus statements.Why This Special Issue MattersThe burden of pancreatitis-associated diabetes is rising worldwide, alongside increasing rates of obesity, alcohol-related disease, gallstone pancreatitis, and metabolic syndrome. However, PPDM remains substantially under-recognised in routine clinical practice. Many patients are misclassified as having Type 2 diabetes, leading to delayed diagnosis of pancreatic exocrine insufficiency and suboptimal treatment.Emerging advances in molecular biology, artificial intelligence, pancreatic imaging, microbiome research, and regenerative medicine are transforming our understanding of pancreatic endocrine dysfunction after pancreatitis. Bringing together multidisciplinary research will help establish standardised diagnostic pathways and identify opportunities for early intervention before irreversible diabetes develops.Types of Manuscripts InvitedWe welcome:· Original Research Articles· Clinical Studies· Randomized and Observational Studies· Translational Research· Animal Studies· Systematic Reviews· Meta-Analyses· Narrative Reviews· Clinical Practice and Consensus Papers· Brief Reports· Perspectives and Commentaries Topic editors: Saurabh Dawra, Ravi Kumar Sharma Source: https://www.frontiersin.org/research-topics/86553/diabetes-after-pancreatitis-timing-mechanisms-and-early-intervention-strategies