According to a survey conducted in India in major countries, it has been shown that 12.1% of the prevalence was seen in urban adults. Diabetes onset was ten years before when compared to western countries and which is noted especially in Asian Indians as per the study conducted.9 The data available in western parts shows that 10% of cases were found to be diabetic to be precisely type3c-DM. There is no solid proof as of now regarding the Asian regions regarding DM.10,11 The main reason for type3c-DM remains chronic pancreatitis only, 80% of type3c-DM is caused in adults about 40-50%, and 20% of them are seen in adolescents. In one study they found around 14.8% of them found in Kerela. The onset age for type3c-DM is from 12-25 years, but in alcohol-induced pancreatic diabetes is fifty to sixty years.11

The human pancreas harbored around ten lakhs (One million) of 5–400-micron diameter of islets. One islet has an average of about 2000 insulin-secreting beta-cells, somatostatin-secreting delta cells, and glucagon-secreting alpha cells. Pancreas also has pancreatic polypeptide-secreting cells. They are present in the pancreas invariably also with pancreatic acini. In the axis named insulo-acinar, the islet secretions affect the functions of acini. Tissue injury When enzymes get prematurely activated, it causes tissue injury, leading to auto digestion and inflammation of pancreas tissue, calcification, septa formation, fibrosis replacement, loss, and finally, exocrine deficiency.11

Pancreatic resection comprehends a wide range of techniques, including distal pancreatectomy, enucleation procedures, and pancreaticoduodenectomy procedures. Pancreatic resection is done for the neoplastic lesions for managing chronic pancreatitis, and malignant, benign, and premalignant lesions. Survival post-pancreatectomy has executed to malignant disease, and also need to understand the effect of T3cDM are increased in the patients in post-pancreatectomy. In distal pancreatectomy assumed more likely resulting in the deficit of glucagon and hypoglycemia because of islets locations more particularly in alpha cells. Specifically, post pancreatectomy DM the deficiency of endocrine is correlated to the area where the pancreas has been resected. Duodenum and pylorus resection shows an effect on glycemic control and the action of incretin, in patients who are undergoing the procedure of pancreaticoduodenectomy has observed an upsurge of secretion of FLP-1, reduced GIP levels, and decreased production of insulin. It is all possible ways that affect the health of the patient in the incidence of pancreatitis (Chronic) and more likely giving a way to develop DM.8

In T3c-DM histopathological studies propose that the pancreas differs from the type-2 and 1, in this condition of pancreatic diabetes the deposition of Cystic Fibrosis-Related Diabetes (CFRD) amyloid has been seen. Occurrence of T3c-DM is seen usually at the age of 59 years i.e., in males, and Body Mass Index (BMI) is found to be 29.2 kg/m2. T3cDM is occurring due to the influence of the exocrine pancreas which is leading to hyperglycemia, studies show that the development of this condition is due to pancreatitis in patients. A study was conducted on 2966 individuals and it was found that the patients with acute pancreatitis were at the verge of risk to develop this condition 2.5 times more than the patient without acute pancreatitis.12

Additive effect to endocrine effect, chronic pancreatitis will lead to the incomplete or whole devastation of pancreatic tissues which in turn leads to the loss of bicarbonate and enzymes that helps in digesting (Digestive enzymes). In pancreatic cancer or Pancreatic Ductal Adenocarcinoma (PDAC), inflammation of the fibrous pancreas is the second risk factor that causes T3DM. This condition is associated with immunopathogenesis, insulin resistance, deficiency, genetic association, and decreased incretin effects, these are five major functional changes that occur in this condition. Blood flows via capillaries through the endocrine pancreas and to the exocrine pancreas which is surrounded by the islets, this system provides endocrine hormones in high concentration i.e., glucagon, somatostatin, insulin, and amylin. The acinar cells encompassed the insulin receptors, which regulate the synthesis of digestive enzymes in the exocrine pancreas. Scar in the pancreas tissues will lead to insulin deficiency and, in turn, to the interplay b/w the acinar tissues and the pancreatic islets. The main mechanism behind T3cDM is fibrosis and the inflammation of the pancreas which progressively leads to the devastation of islets. Beta cell destruction is due to stressful inflammation and cytokines.12