Journal
UNITED EUROPEAN GASTROENTEROLOGY JOURNAL
Volume 11, Issue 1, Pages 79-91Publisher
JOHN WILEY & SONS LTD
DOI: 10.1002/ueg2.12344
Keywords
chronic pancreatitis; complications; diabetes mellitus; insulin; post-pancreatitis
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This study aimed to determine the incidence and predictors of post-pancreatitis diabetes mellitus (PPDM) after chronic pancreatitis (CP), as well as the complications and antidiabetic therapy requirements. Retrospective data from 481 patients with definite CP were analyzed, and the cumulative incidence of PPDM at 5, 10, 15, and 20 years was determined. The presence of pancreatic calcifications was identified as the only independent predictor of PPDM. Compared to CP patients without diabetes, patients with PPDM had higher rates of complications and were more commonly prescribed insulin and metformin.
BackgroundPost-pancreatitis diabetes mellitus (PPDM) is a common consequence of chronic pancreatitis (CP). We aimed to determine the incidence and predictors of PPDM after CP onset, as well as complications and antidiabetic therapy requirements, in a high-volume tertiary center. MethodsWe did a cohort study with retrospectively collected data from patients with definite CP seen at the Karolinska University Hospital between January 1999 and December 2020. Cause-specific Cox regression analysis was used to assess PPDM predictors. To estimate risk of complications and need for therapy the Fine-Gray subdistribution hazard model was employed, accounting for death as a competing risk. ResultsWe identified 481 patients with CP. The cumulative incidence of PPDM was 5.1%, 13.2%, 27.5% and 38.9% at 5, 10, 15 and 20 years, respectively. Compared to CP patients without diabetes, patients with PPDM were predominantly male (55% vs. 75%), had more frequently alcoholic etiology (44% vs. 62%) and previous acute pancreatitis. The only independent predictor of PPDM was presence of pancreatic calcifications (aHR = 2.45, 95% CI 1.30-4.63). Patients with PPDM had higher rates of microangiopathy (aSHR = 1.59, 95% CI 1.02-2.52) and infection (aSHR = 4.53, 95% CI 2.60-9.09) compared to CP patients who had type 2 diabetes (T2DM). The rate of insulin use was three-fold higher, whereas metformin use rate was two-fold higher in the same comparison. ConclusionsPatients with PPDM have a higher frequency of clinically significant complications and were more commonly prescribed insulin and metformin, suggesting a more aggressive phenotype than that of T2DM. Greater PPDM awareness is needed to optimize disease management.
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