The Role of the Exocrine Pancreas in Diabetes Pathophysiology and Care

Diabetes has traditionally been viewed as a disorder of the endocrine pancreas, characterized by impaired insulin action and dysregulated glucose homeostasis. However, growing evidence indicates that the exocrine pancreas also plays a critical role in diabetes pathophysiology. Structural, functional, and inflammatory alterations of the exocrine pancreas have been observed across the spectrum of diabetes, including type 1 diabetes, type 2 diabetes, pancreatogenic (type 3c) diabetes including cystic fibrosis-related diabetes, and monogenic forms of the disease. Conversely, diabetes itself can contribute to exocrine pancreatic dysfunction, creating a complex bidirectional relationship that has important implications for disease progression, diagnosis, nutritional status, and patient care. Despite increasing recognition of the endocrine-exocrine axis, many aspects of this interaction remain poorly understood and underappreciated in both research and clinical practice.This Research Topic aims to advance understanding of the role of the exocrine pancreas in diabetes pathophysiology and care. We welcome multidisciplinary contributions spanning basic, translational, and clinical research that investigate the mechanisms linking exocrine pancreatic dysfunction with diabetes development, progression, complications, and treatment. Particular emphasis will be placed on studies that improve disease classification, identify novel biomarkers, clarify endocrine-exocrine interactions, and inform more comprehensive approaches to diabetes diagnosis and management.Potential themes include, but are not limited to:• Endocrine-exocrine crosstalk in diabetes pathophysiology• Exocrine pancreatic dysfunction in type 1, type 2, and pancreatogenic (type 3c) diabetes• Mechanisms linking pancreatic inflammation, fibrosis, and diabetes• Pancreatic enzyme insufficiency and its impact on glycemic control, nutrition, and metabolic health• Imaging, histopathology, and functional assessment of the exocrine pancreas in diabetes• Biomarkers of exocrine pancreatic dysfunction and their diagnostic or prognostic value• Pancreatic diseases, including pancreatitis and pancreatic cancer, in relation to diabetes• Cystic fibrosis-related diabetes and other disorders involving combined endocrine and exocrine dysfunction• Therapeutic strategies targeting exocrine pancreatic disease and their effects on diabetes outcomes• Precision medicine approaches integrating endocrine and exocrine pancreatic assessment into diabetes careThis collection seeks to highlight the growing importance of the exocrine pancreas in diabetes research and encourage new perspectives on the mechanisms, diagnosis, and clinical management of diabetes through a more integrated understanding of pancreatic biology. Topic editors: Brittany Bruggeman, Taylor M Triolo Source: https://www.frontiersin.org/research-topics/85153/the-role-of-the-exocrine-pancreas-in-diabetes-pathophysiology-and-care