IAPP and Insulin resistance: Alongside the various causes of β cell impairment and decreased numbers mentioned above, epidemiological, and clinical studies suggest that PDAC-DM is possibly a paraneoplastic phenomenon mediated by DM-causing substances.301 Insulin resistance has been implicated in the pathogenesis of PDAC-DM, which is present in patients with PDAC (normal fasting glucose levels) and disappears after surgical resection.301 Islet amyloid polypeptide (IAPP) is believed to be involved in this process.