Multiple Factors Associated With Diabetes in Patients With Chronic Pancreatitis

A study published in Diabetes Care found multiple factors associated with diabetes in patients with chronic pancreatitis (CP), including factors that were associated with pancreatic severity.

CP is a condition that is characterized by pain and maldigestion of nutrients. The disease can lead to many complications, including the development of CP-associated diabetes mellitus (CP-DM). The prevalence of CP-DM is 30% to 40% in adults with CP, according to previous cross-sectional analyses. This study aimed to present an analysis of risk factors for diabetes in patients with CP.

The researchers used data from the Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED) study, which is a multicenter, longitudinal cohort study of CP in the United States. Patients were included if they were aged 18 to 75 years and were enrolled in PROCEED from June 2017 to August 2021. A patient had CP if they had pancreatic parenchymal and/or ductal calcifications and/or Cambridge stage 3 to 4 findings on their cross-sectional imaging, or had histologic evidence of CP.

Demographic data were collected from all participants. A complete assessment of diabetes status was also obtained from participants. Participants without a known history of diabetes underwent assessment of their blood glucose and hemoglobin A_1c levels. Participants were separated into 3 groups: the prepancreatitis DM group, whose diagnosis was a least 1 year before the first diagnosis of pancreatitis; the concurrent DM group, whose diabetes was diagnosed within 1 year of pancreatitis; and the postpancreatitis DM group, which included participants whose diabetes was diagnosed at least 1 year after the pancreatitis diagnosis.

There were 645 patients included in this study who had a confirmed diagnosis of CP; 276 had diabetes and 369 did not at baseline. Prevalent diabetes was associated with older age, being overweight or obese, male sex, non-White race, history of more than 20 pack-years of cigarette smoking, history of pancreatic surgery, family history of diabetes, pancreatic calcifications, and pancreatic atrophy (all P < .05).

Duration of pancreatitis, Hispanic ethnicity, tobacco use, nonalcoholic etiology of pancreatitis, and history of acute pancreatitis complications each had borderline significant associations with diabetes.

A multivariable regression model was used for the 3 different diabetes definitions. Overweight or obese status, male sex, and nonalcoholic etiology were all associated with increased prevalence of diabetes in the 3 groups. Hispanic ethnicity, common bile duct stricture, and exocrine pancreatic dysfunction (EPD) were all associated with prepancreatitis DM and concurrent DM, whereas acute pancreatitis complications and atrophy were associated with concurrent DM and postpancreatitis DM.

Prepancreatitis DM was associated with age, other race (non-Black vs White), and family history of diabetes. Concurrent DM was associated with smoking history and EPD not tested. Postpancreatitis DM was associated with Black race, pancreatic surgery, and pancreatic calcifications.

Area under the receiver operating characteristic curve (AUROC) was used to assess the performance of the multivariable models. The AUROC was 0.745 (95% CI, 0.693-0.796) in the main analysis of all participants, 0.809 (95% CI, 0.715-0.890) in the analysis of prepancreatitis DM, 0.736 (95% CI, 0.614-0.830) for concurrent DM, and 0.705 (95% CI, 0.624-0.777) for postpancreatitis. The values were found to indicate a good ability of the models to discriminate CP with and without diabetes. A cross validation by institution found similar performances.

There were some limitations to this study. The sample sizes were relatively modest in the subanalyses, which may explain some unexpected results. Also, there were 246 participants who did not have testing for EPD.

The researchers concluded that this study’s findings may help to characterize “risk factors that could be used clinically to identify which patients with CP are at the greatest risk of developing diabetes in the future so that preventive measures can be instituted.”

Reference

Jean C, Hart PA, Li L, et al. Development of a clinical prediction model for diabetes in chronic pancreatitis: the PREDICT3c study. Diabetes Care. 2023;46:1-10. doi:10.2337/dc22-1414