United European Gastroenterol J. 2023;11(1):79–91

Dugic A, Hagström H, Dahlman I, Rutkowski W, Daou D, Kulinski P, Löhr JM, Vujasinovic M

Post-pancreatitis diabetes mellitus is common in chronic pancreatitis and is associated with adverse outcomes

Background: Post-pancreatitis diabetes mellitus (PPDM) is a common consequence of chronic pancreatitis (CP). The authors 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.
Methods: They 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.
Results: 481 patients with CP were identified. 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 (adjusted hazard ratio [aHR] = 2.45, 95% confidence interval [CI]: 1.30–4.63). Patients with PPDM had higher rates of microangiopathy (adjusted subdistribution hazard ratio [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. The rate of insulin use was 3-fold higher, whereas metformin use rate was 2-fold higher in the same comparison.

Conclusions: Patients with post-pancreatitis diabetes mellitus (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 type 2 diabetes. Greater PPDM awareness is needed to optimize disease management.

Dr. A. Dugic, Department of Medicine, Huddinge Karolinska Institutet, Stockholm, Sweden,

DOI: DOI: 10.1002/ueg2.12344

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