Core Viewpoint - The article discusses the challenges and recent findings in the treatment of type 3c diabetes, emphasizing the impact of pancreatic exocrine insufficiency (PEI) on treatment efficacy and the need for individualized treatment strategies [4][5][7][15]. Group 1: Overview of Type 3c Diabetes - Type 3c diabetes is a special type of diabetes caused by pancreatic diseases such as acute/chronic pancreatitis, pancreatic tumors, cystic fibrosis, and pancreatic surgery, with a prevalence of 5%-10% in Western populations [4]. - There is currently a lack of targeted treatment guidelines for type 3c diabetes, leading to reliance on standards for type 1 and type 2 diabetes, which may not be effective [5]. Group 2: Research Findings - A landmark study by the University of Exeter evaluated the efficacy and safety of oral hypoglycemic agents in 7,084 type 3c diabetes patients, comparing them with 97,000 type 2 diabetes patients [9]. - The study found that the presence of PEI significantly reduces the effectiveness of diabetes medications, with HbA1c levels decreasing by only 9.4 mmol/mol in PEI patients compared to 12.2 mmol/mol in non-PEI patients [10][11]. Group 3: Drug Efficacy and Risks - Five classes of oral hypoglycemic agents (metformin, sulfonylureas, DPP-4 inhibitors, pioglitazone, SGLT2 inhibitors) were found to be effective, but their efficacy is diminished in patients with PEI [7][12]. - The risk of discontinuation of treatment is doubled in PEI patients (OR=2.03), indicating a need for closer monitoring [13]. Group 4: Clinical Implications - For non-PEI type 3c diabetes patients, oral hypoglycemic agents are reliable and should be prioritized [14]. - For patients with PEI, there is a need to be cautious about reduced efficacy and higher discontinuation risks, suggesting potential adjustments in treatment plans [14]. - SGLT2 inhibitors may be more suitable for PEI patients needing weight loss, while sulfonylureas may help mitigate weight gain [14]. Group 5: Significance of the Research - The findings provide crucial insights for the precise treatment of type 3c diabetes, indicating that future guidelines may need to differentiate treatment strategies based on the presence of PEI [15].