Background The diagnostic criteria of fibrocalculous pancreatic diabetes (FCPD) are relatively lagging behind. Early identification and intervention can improve the prognosis, but it is difficult to differentiate FCPD from other types of diabetes.

Objective To investigate the diagnosis of FCPD, as well as the differentiation between FCPD and type 1 diabetes (T1DM), type 2 diabetes (T2DM) and alcoholic chronic pancreatitis (ACP) secondary diabetes, so as to provide new ideas for the diagnosis and treatment of FCPD.

Methods The clinical characteristics, diagnosis and treatment of 3 diabetic patients with pancreatic calcification or pancreatic calculi in our hospital from April 2006 to April 2020 were analyzed, and the relevant literatures were reviewed.

Results Case 1 was a 30-year-old male with T1DM, and secondary changes in the pancreas were not excluded. Case 2 was a 33-year-old male with typical FCPD characteristics. Case 3 was a 43-year-old male, diagnosed as chronic pancreatitis with pancreatic stones and secondary diabetes, ACP or FCPD were considered. All three patients came from non-tropical areas, including one case ate cassava and they all had a history of drinking in different degrees. One patient had abdominal pain since childhood, and all three patients denied lipodiarrhea. All three patients were accompanied by islet dysfunction, 2 patients were positive for diabetes-related antibodies, and only one patient developed ketosis. Pancreatic calcification and pancreatic duct stones were confirmed by ultrasound, CT and MRI respectively.

Conclusion More attention should be paid to the characteristic imaging changes of pancreatic calculus and pancreatic duct dilation in the diagnosis of FCPD. History of alcohol consumption is not a specific condition to differentiate FCPD from ACP secondary diabetes.