Incidence of New Onset Diabetes Mellitus Secondary to Acute Pancreatitis: A Systematic Review and Meta-Analysis

Zhi, Mengmeng; Zhu, Xiangyun; Lugea, Aurelia; Waldron, Richard T.; Pandol, Stephen J.; Li, Ling

doi:10.3389/fphys.2019.00637

Cited by 76 publications

(98 citation statements)

References 73 publications

(146 reference statements)

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“…This, and other data, suggests that the theory of greater islet cell loss, leads to greater risk of developing T3cDM and impaired glucose metabolism. This has been supported by several studies [ 16 , 18 , 21 – 23 ]. Of note, some of these studies have predominantly severe cases, while others have a majority of mild cases, and often direct cohort comparison was difficult.…”

Section: Predictors Of Diabetes Of the Exocrine Pancreassupporting

confidence: 77%

“…Another meta-analysis conducted in 2019 showed a similar pooled incidence of 23% [ 18 ]. Upon further sub-analysis, the investigators found the pooled incidence within 5 years was 20% and after 5 years was 37%, showing a trend for increased development of endocrine dysfunction over time.…”

Section: Incidence/prevalencementioning

confidence: 99%

“…Of note, some of these studies have predominantly severe cases, while others have a majority of mild cases, and often direct cohort comparison was difficult. The meta-analysis, however, was able to compare larger cohorts of severe AP and mild AP and found an incidence of DM of 39% compared to 14%, respectively [ 18 ].…”

Section: Predictors Of Diabetes Of the Exocrine Pancreasmentioning

confidence: 99%

“…It is well established that the three most common causes of AP are: gallstone, alcohol, and hypertriglyceridemia [ 4 ]. Several studies found that alcohol was associated with greater risk of developing T3cDM [ 18 , 19 ]. These studies postulate that alcohol’s effect on the pancreas directly and via its metabolites leads to multiple pathways of damage ultimately leading to atrophy, fibrosis, and premature activation of digestive enzymes.…”

Section: Predictors Of Diabetes Of the Exocrine Pancreasmentioning

confidence: 99%

“…These studies postulate that alcohol’s effect on the pancreas directly and via its metabolites leads to multiple pathways of damage ultimately leading to atrophy, fibrosis, and premature activation of digestive enzymes. Furthermore, the specific activation of pancreatic stellate cells (by metabolites) leads to ongoing inflammatory response, fibrosis, and damage after the initial insult occurs [ 18 ]. Others, however, have found no significant association with etiology and development of T3cDM [ 16 , 17 , 22 ] suggesting confounding variables exist with alcoholic pancreatitis and development of T3cDM.…”

Section: Predictors Of Diabetes Of the Exocrine Pancreasmentioning

confidence: 99%

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Acute pancreatitis and diabetes mellitus: a review

Richardson

Park

2021

Korean J Intern Med

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Diabetes following acute pancreatitis (AP) is becoming increasingly recognized. It is unclear what subtype of diabetes mellitus (DM) occurs; however, type 3c diabetes mellitus (T3cDM) is gaining increasing recognition. T3cDM has differing pathophysiology than other subtypes of DM and therefore differing disease course and treatment. Current studies have examined the incidence and prevalence of DM following AP, and meta-analyses have shown around 15% develop DM at 1 year with an increasing proportion developing DM at 5 years. It has been observed that some patients have transient hyperglycemia following AP episode with a subset developing persistent impaired glucose metabolism; however, the exact timeline is not well defined. The data on risk factors for developing DM after AP is limited and mixed; however, it is likely that severity of AP may impact the propensity to develop DM. Screening guidelines have not been established following AP; however, screening 1-year post-event will likely capture a sizable proportion of newly developed DM. The endocrine and exocrine pancreas are closely linked, and studies have found significant overlap in dysfunction of both after AP. Finally, there are some data to suggest that diabetes predisposes patients to structural changes in the pancreas and increased risk of developing AP.

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Section: Predictors Of Diabetes Of the Exocrine Pancreassupporting

confidence: 77%

Section: Incidence/prevalencementioning

confidence: 99%

Section: Predictors Of Diabetes Of the Exocrine Pancreasmentioning

confidence: 99%

Section: Predictors Of Diabetes Of the Exocrine Pancreasmentioning

confidence: 99%

Section: Predictors Of Diabetes Of the Exocrine Pancreasmentioning

confidence: 99%

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Acute pancreatitis and diabetes mellitus: a review

Richardson

Park

2021

Korean J Intern Med

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Acute Pancreatitis

Mederos

Reber

Girgis

2021

JAMA

487

321

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cute pancreatitis is one of the most common gastrointestinal conditions that results in hospital admission in the United States. The incidence of acute pancreatitis is estimated at 110 to 140 per 100 000 population, with an estimated more than 300 000 US emergency department visits per year. 1,2 Admissions due to acute pancreatitis have increased from 9.48 cases per 1000 hospitalizations in 2002 to 12.19 in 2013, with a median hospital cost of nearly $7000 per hospitalization. 3,4 Acute pancreatitis is a complex disease with a variable course that is often difficult to predict early in its development (eBox in the Supplement). Approximately 80% of patients develop mild to moderately severe disease (absence of organ failure >48 hours). 5,6 However, one-fifth of patients develop severe disease, with a mortality rate of approximately 20%. 5,7 The purpose of this review is to summarize evidence regarding the recognition of disease severity, fluid and nutrition management, and risk-reduction methods for the prevention of recurrent disease. MethodsPubMed and the Cochrane databases were searched for Englishlanguage studies published from January 2009 through August 2020 for randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies. Manual searches were performed of the references of selected articles, reviews, metaanalyses, and practice guidelines. Select studies prior to 2009 were included for historical context. Emphasis was given to RCTs and metaanalyses. All publications and citations included were mutually agreed on by the authors and selected for clinical importance and relevance with consideration to the general medical readership of JAMA. Sixty-six articles were included, which contained 8 RCTs, 12 meta-analyses, and 5 clinical guidelines. Pathogenesis and EtiologyAcute pancreatitis is characterized by damage to the acinar cells, the functional units of the exocrine pancreas, precipitating inappropriate release and activation of trypsinogen to trypsin within the acini. This triggers the activation of other digestive enzymes, the kinin system, and the complement cascade resulting in autodigestion of the pancreatic parenchyma. 8,9 Pancreatic duct obstruction (eg, gallstone pancreatitis) is one of the more common causes of acinar damage, causing an increase in ductal pressure, interstitial edema, and accumulation of enzyme-rich fluid within the pancreatic tissue. 10 Alternatively, primary acinar injury may be caused by a variety of other factors, such as calcium, which regulates trypsin activation. Inappropriate release of IMPORTANCE In the United States, acute pancreatitis is one of the leading causes of hospital admission from gastrointestinal diseases, with approximately 300 000 emergency department visits each year. Outcomes from acute pancreatitis are influenced by risk stratification, fluid and nutritional management, and follow-up care and risk-reduction strategies, which are the subject of this review.OBSERVATIONS MEDLINE was searched via PubMed as was the Cochrane data...

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Pancreatic Crosstalk in the Disease Setting: Understanding the Impact of Exocrine Disease on Endocrine Function

Villaca,

Mastracci

2024

Comprehensive Physiology

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The exocrine and endocrine are functionally distinct compartments of the pancreas that have traditionally been studied as separate entities. However, studies of embryonic development, adult physiology, and disease pathogenesis suggest there may be critical communication between exocrine and endocrine cells. In fact, the incidence of the endocrine disease diabetes secondary to exocrine disease/dysfunction ranges from 25% to 80%, depending on the type and severity of the exocrine pathology. Therefore, it is necessary to investigate how exocrine‐endocrine “crosstalk” may impact pancreatic function. In this article, we discuss common exocrine diseases, including cystic fibrosis, acute, hereditary, and chronic pancreatitis, and the impact of these exocrine diseases on endocrine function. Additionally, we review how obesity and fatty pancreas influence exocrine function and the impact on cellular communication between the exocrine and endocrine compartments. Interestingly, in all pathologies, there is evidence that signals from the exocrine disease contribute to endocrine dysfunction and the progression to diabetes. Continued research efforts to identify the mechanisms that underlie the crosstalk between various cell types in the pancreas are critical to understanding normal pancreatic physiology as well as disease states. © 2024 American Physiological Society. Compr Physiol 14:5371‐5387, 2024.

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Incidence of New Onset Diabetes Mellitus Secondary to Acute Pancreatitis: A Systematic Review and Meta-Analysis

Cited by 76 publications

References 73 publications

Acute pancreatitis and diabetes mellitus: a review

Acute pancreatitis and diabetes mellitus: a review

Acute Pancreatitis

Pancreatic Crosstalk in the Disease Setting: Understanding the Impact of Exocrine Disease on Endocrine Function

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