Glucose variability during the early course of acute pancreatitis predicts two‐year probability of new‐onset diabetes: A prospective longitudinal cohort study

Abstract

Background Acute pancreatitis (AP) is the largest contributor to diabetes of the exocrine pancreas. However, there is no accurate predictor at the time of hospitalisation for AP to identify individuals at high risk for new‐onset diabetes. Objective To investigate the accuracy of indices of glucose variability (GV) during the early course of AP in predicting the glycated haemoglobin (HbA1c) trajectories during follow‐up. Methods This was a prospective longitudinal cohort study of patients without diabetes at the time of hospitalisation for AP. Fasting blood glucose was regularly measured over the first 72 h of hospital admission. The study endpoint was the HbA1c trajectories ‐ high‐increasing, moderate‐stable, normal‐stable ‐ over two years of follow‐up. Multinomial logistic regression analyses were conducted to investigate the associations between several common GV indices and the HbA1c trajectories, adjusting for covariates (age, sex, and body mass index). A sensitivity analysis constrained to patients with non‐necrotising AP was conducted. Results A total of 120 consecutive patients were studied. All patients in the high‐increasing HbA1c trajectory group had new‐onset diabetes at 18 and 24 months of follow‐up. Glycaemic lability index had the strongest significant direct association (adjusted odds ratio = 13.69; p = 0.040) with the high‐increasing HbA1c trajectory. High admission blood glucose, standard deviation of blood glucose, and average real variability significantly increased the patients' odds of taking the high‐increasing HbA1c trajectory by at least two‐times. Admission blood glucose, but not the other GV indices, had a significant direct association (adjusted odds ratio = 1.46; p = 0.034) with the moderate‐stable HbA1c trajectory. The above findings did not change materially in patients with non‐necrotising AP alone. Conclusions High GV during the early course of AP gives a prescient warning of worsening HbA1c pattern and new‐onset diabetes after hospital discharge. Determining GV during hospitalisation could be a relatively straightforward approach to early identification of individuals at high risk for new‐onset diabetes after AP.

Factors Affecting the Circulating Levels of Oxyntomodulin in Health and After Acute Pancreatitis

“…60 Given that oxyntomodulin and amylin showed inverse associations in individuals after AP, the pathophysiological changes that take place after an episode of AP (such as insulin resistance) may modulate the interaction between amylin and oxyntomodulin. [61][62][63][64] The present study had several limitations. First, all blood biomarkers were measured in the fasted state only.…”

“…It is conceivable that an increase in HbA 1c levels 58 and the presence of insulin resistance after AP may cause overexpression of amylin, mitigating its anorexigenic properties 60 . Given that oxyntomodulin and amylin showed inverse associations in individuals after AP, the pathophysiological changes that take place after an episode of AP (such as insulin resistance) may modulate the interaction between amylin and oxyntomodulin 61–64 …”

Relationship of Serum Bile Acids with Fat Deposition in the Pancreas, Liver, and Skeletal Muscle

“…Also, the present study included people with a history of acute pancreatitis, 45,46 as the project focusing on this population had received funding. 47,48 Nevertheless, a complete clinical resolution was observed in all study participants at the time of magnetic resonance image acquisition. [20][21][22][23] The protocol to measure IHFD in the present study might have been suboptimal as we did not use T1 and T2 correction of water signal and lipid signal from single echo magnetic resonance spectroscopy data.…”

Blood glucose variability in patients with acute pancreatitis

“…regarding blood glucose variability (GV) during the course of acute pancreatitis with great interest. 1 Although it has been shown that around 23% of patients with acute pancreatitis develop diabetes mellitus within 3 years discharge from hospital, 2 , 3 the pathophysiology of acute pancreatitis associated diabetes is poorly understood. However, Bharmal et al.…”

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Blood glucose variability in patients with acute pancreatitisI have read the original article by Bharmal et al regarding blood glucose variability (GV) during the course of acute pancreatitis with great interest. 1 Although it has been shown that around 23% of patients with acute pancreatitis develop diabetes mellitus within 3 years discharge from hospital, 2,3 the pathophysiology of acute pancreatitis associated diabetes is poorly understood. However, Bharmal et al identified increased GV during the course of acute pancreatitis as a risk factor of developing diabetes.

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