Evaluation of a Mixed Meal Test for Diagnosis and Characterization and Type 3c Diabetes Mellitus Secondary to Pancreatic Cancer and Chronic Pancreatitis (DETECT)

Inclusion Criteria:

All patients must sign an informed consent indicating that they are aware of the
investigational nature of this study. Patients must have signed an authorization for the
release of their protected health information.

   - Patients must be ages ≥30 and <85.

   - Patients must have a diagnosis of one of the following based on study definitions

   - New Onset Diabetes (<3 years) in subjects with Pancreatic Cancer (PDAC);

   - New Onset Diabetes (<3 years) in subjects with Chronic Pancreatitis;

   - New Onset Diabetes (<3 years) in subjects without Pancreatic disease (i.e., T2DM)

   - Long standing T2DM (≥3 years) without Pancreatic disease

   - Long standing diabetes (≥3 years) in subjects with PDAC

   - Long standing diabetes (≥3 years) subjects with chronic pancreatitis

   - non-diabetic subjects with PDAC

   - non-diabetic subjects with chronic pancreatitis

   - non-diabetic controls without Pancreatic disease

Exclusion Criteria:

   - Subjects must not have any significant medical illnesses (including diabetes) that in
   the investigator's opinion cannot be adequately controlled with appropriate therapy or
   would compromise the patient's ability to tolerate study interventions.

   - Diabetes not stable enough to permit holding of diabetes medications in subjects
   undergoing mixed meal tolerance testing.

   - Subjects taking higher doses of insulin (≥0.75 unit/kg/day).

   - Subjects in the non-pancreatic disease subgroup (i.e., T2DM) on longer acting agents,
   including thiazolidinediones and once-weekly GLP-1 agonists (Bydureon [exenatide],
   Ozempic [semaglutide], Trulicity [dulaglutide]). Conversely, the use of these
   medications is permitted for subjects in the CP and PDAC groups.

   - Patients currently receiving oral steroid medications.

   - Hospitalization for acute pancreatitis within 2 months before study visit (with the
   exception of subjects enrolled into the PDAC group, as this may be a symptom of the
   disease).

   - The presence of a symptomatic cyst in subjects with CP. The presence of a cyst in
   subjects with pancreatic cancer is not an exclusion, including cancer arising from a
   mucinous cystic lesion.

   - Any subject with a known pancreatic cancer histologic subtype other than
   adenocarcinoma (e.g., subjects with pancreatic neuroendocrine tumors are excluded).

   - Previous pancreatic surgery (including total pancreatectomy, pancreaticoduodenectomy,
   distal pancreatectomy, pancreaticojejunostomy, enucleation, or Frey procedure). An
   exception to this criterion are subjects with CP who had a history of surgery
   (including pancreaticoduodenectomy, pancreatic ojejunostomy, distal pancreatectomy, or
   Frey).

   - Previous treatment for pancreatic cancer, including chemotherapy or radiation.

   - Previous vagotomy or gastric surgery, including endoscopic gastric reduction
   procedures.

   - Previous diagnosis of gastroparesis.

   - Patients on treatment for any cancer (except non-melanoma skin cancer or carcinoma
   in-situ of the cervix).

   - Allergy or intolerance to ingredients in Boost drink in subjects undergoing mixed meal
   testing