Pancreatogenic diabetes in immunoglobulin G4-related autoimmune pancreatitis managed with automated insulin delivery.

Authors

Saraswathi Saiprasad, Theresa Cao, Narayana Swamy

Published in

JCEM case reports. Volume 4. Issue 8. Pages luag174. Epub Jul 13, 2026.

Abstract

Immunoglobulin G4 (IgG4)-related autoimmune pancreatitis (AIP) may mimic malignancy and lead to progressive pancreatic dysfunction. We describe a 75-year-old man with pancreatic mass lesions, biliary strictures, and elevated carbohydrate antigen 19-9 levels concerning for malignancy. Repeated pancreatic and biliary biopsies demonstrated chronic pancreatitis and fibrosis without carcinoma. Elevated IgG4 levels of 193.5 mg/dL (SI: 1.94 g/L; reference 4-86 mg/dL [SI: 0.04-0.86 g/L]) together with biopsy findings supported AIP. He developed severe exocrine and endocrine pancreatic dysfunction with worsening hyperglycemia and weight loss. Hemoglobin A1c (HbA1c) increased from 7% (SI: 53 mmol/mol) to >17% (SI: >163 mmol/mol; reference 3.8-5.6% [SI: 18-38 mmol/mol]). Autoimmune diabetes antibodies were negative. C-peptide declined over 6 weeks from 1.77 ng/mL (SI: 0.59 nmol/L) to 0.80 ng/mL (SI: 0.26 nmol/L) (reference 1.10-5.50 ng/mL [SI: 0.36-1.82 nmol/L]), supporting pancreatogenic diabetes. Automated insulin delivery achieved sustained glycemic improvement, with HbA1c improving to 7.6% (SI: 60 mmol/mol) at the most recent 18-month follow-up. This case highlights progressive endocrine failure and the utility of advanced diabetes technology in AIP-associated pancreatogenic diabetes.

PMID:
42438809
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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