Effect of the disease severity on the risk of developing new-onset diabetes after acute pancreatitis

Abstract

Endocrine pancreatic insufficiency secondary to acute pancreatitis (AP) drew increasing attention in the recent years. The aim of the present study was to assess the impact of pancreatic necrosis and organ failure on the risk of developing new-onset diabetes after AP.The follow-up study was conducted for patients recovered from AP in the treatment center of Jinling Hospital. Endocrine function was evaluated by simplified oral glucose tolerance test (OGTT). Pancreatic necrosis was examined by abdominal contrast-enhanced CT (CECT) scan during hospitalization. The data including APACHE II score, Balthazar's score, organ failure (AKI and ARDS) was also collected from the medical record database. All patients were divided into group diabetes mellitus (DM) and group non-DM according to the endocrine function and group pancreatic necrosis (PN) and persistent organ failure (OF), group PN and non-OF, group non-PN and OF, and group non-PN and non-OF according to the occurrence of pancreatic necrosis and persistent organ failure.Around 256 patients were included for the final analysis. 154 patients (60.2%) were diagnosed with DM (include impaired glucose tolerance, IGT), while 102 patients (39.8%) were deemed as normal endocrine function. APACHE II score and Balthazar score of the patients in the group DM were significant higher than those in the non-DM group (F = 6.09, P = .01; F = 10.74, P = .001). The incidence of pancreatic necrosis in group DM and group non-DM was, respectively, 64.7% and 53.0% (χ = 3.506, P = .06). The patients underwent necrosis debridement by percutaneous catheter drainage (PCD) and/or the operative necrosectomy (ON) were more likely to developed new onset DM than the patients without PCD or ON (χ = 2.385, P = .02). The morbidity of new-onset DM after AP gradually increased from group non-PN and non-OF, group non-PN and OF, group PN and non-OF to group PN and OF in order (χ = 4.587, P = .03). The value of HOMA-IR of patients at follow-up time was significant higher in group DM than group non-DM (F = 13.414, P = .000).Patients with both PN and persistent OF may were at increased risk of developing new-onset diabetes after AP. Insulin resistance could be the pivotal mechanism of the development of diabetes.

New-Onset Diabetes Mellitus After the First Attack of Acute Pancreatitis: A Systematic Review and Meta-Analysis

“…The search retrieved a total number of 4834 studies of which, 65 relevant papers were included in the assessment. Finally, 12 studies were used in the analysis (Figure 1) (16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Cohen's kappa coefficient was 0.773 (95% CI: 0.610 -0.936), which indicates a strong consistency.…”

“…All the studies performed prospective cohorts. Eight studies (16,27,29,30,(32)(33)(34)(35) were conducted in Europe, three (25,26,31) in Asia, and one (28) in South America. All studies were conducted in single centers.…”

“…The pooled prevalence of prediabetes was 31% (95% CI: 11% to 90%) and heterogeneity between the studies did not decrease (I 2 = 77%). Sensitivity analysis involved studies that used the 1999 WHO definitions (21), including three studies (25,26,33) with 415 patients. The pooled prevalence was 28% (95% CI: 24% to 33%), with no statistical heterogeneity between studies (I 2 = 0%).…”

“…There were 11 studies (16,(25)(26)(27)(28)(29)(30)(32)(33)(34)(35) reported on newonset DM. They included 707 patients with a pooled diabetes prevalence of 18% (95% CI: 11% to 26%).…”

Evidence-based pancreatology 2018 (review of research results on diseases and exocrine pancreatic insufficiency)

“…Вероятность развития эндокринной недостаточности ПЖ после острого панкреатита изучалась в одноцентровом исследовании J. Tu et al [36]. Состояние эндокринной функции ПЖ оценивали с помощью определения глюкозы крови натощак и теста толерантности к глюкозе.…”