Fibrocalculous pancreatic diabetes (FCPD) is a unique form of diabetes
secondary to chronic pancreatitis seen in developing countries of the
world associated with either overt protein-calorie malnutrition or, m
ore likely, with deficiency of certain micronutrients. FCPD affects yo
ung individuals and runs an aggressive course to reach the endpoints o
f diabetes, pancreatic calculi and exocrine pancreatic dysfunction (st
eatorrhoea) in the majority of cases. There are characteristic feature
s of FCPD radiologically, ultrasonographically, on endoscopic retrogra
de cholangiopancreatography and on histopathology which distinguish it
from chronic pancreatitis of other aetiologies seen in temperate zone
s, e.g. alcoholic chronic pancreatitis. Although a secondary form of d
iabetes, specific diabetes-related complications like retinopathy and
nephropathy do occur in FCPD. There appears to be a high risk of devel
oping pancreatic carcinoma. Although the aetiology of FCPD is still un
clear, the role of micronutrient (antioxidant) deficiency is emerging
as a possible aetiological or predisposing factor. The contribution of
genetic factors and environmental toxins, e.g. cyanogenic glycosides
or other nutritional/toxic factors, merit further study. Studies on FC
PD, a good model of a secondary form of diabetes, could lead to improv
ed understanding of other primary forms of diabetes as well. If the un
derlying aetiological factors are identified, it may also be possible
to prevent this type of diabetes. (C) 1998 John Wiley & Sons, Ltd.