New-onset prediabetes, diabetes after acute pancreatitis: A prospective cohort study with 12-month follow-up

Akbar, Wahid; Unnisa, Misbah; Tandan, Manu; Murthy, H. V. V.; Nabi, Zaheer; Basha, Jahangeer; Chavan, Radhika; Lakhtakia, Sundeep; Ramchandani, Mohan; Kalapala, Rakesh; Koutarapu, Chandrakant; Gangdany, Zaid Mohd; Reddy, D. Nageshwar; Talukdar, Rupjyoti

doi:10.1007/s12664-022-01288-7

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…Overall, our results highlight the lack of definitive knowledge about and the complexity of postacute pancreatitis diabetes and suggest that likely diabetes in pancreatitis subjects has multifactorial etiologies. Prospective studies dedicated to The frequency of prediabetes or diabetes after a single episode of acute pancreatitis that we observed is higher than previously reported in pediatric studies [11] and similar to adult studies examining glucose homeostasis over the firstyear postacute pancreatitis attack [1][2][3]. As previously stated, severity of pancreatitis appeared to mediate an increased risk of abnormal glucose testing within the first-year postacute pancreatitis in our patients.…”

Section: Discussionsupporting

confidence: 78%

“…Hyperglycemia was historically considered a transient complication of acute pancreatitis with permanent diabetes only occurring after chronic disease as the pancreas undergoes necrosis and fibrosis from long-term disease. Over the last 10 years, diabetes has become an increasingly recognized complication after a single episode of acute pancreatitis in adults [1][2][3][4] and there are ongoing efforts to understand the underlying pathophysiology and natural history [5]. Diabetes after acute pancreatitis is likely a heterogenous entity with multiple pathophysiological mechanisms contributing to its development in pancreatitis patients, including insulin resistance, insulin deficiency, altered metabolism of gut hormones and iron, and islet cell autoimmunity [6,7].…”

Section: Introductionmentioning

confidence: 99%

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High Rate of Islets Autoimmunity in Pediatric Patients with Index Admission of Acute Pancreatitis

Tatum,

Hornung,

Bellin

et al. 2023

Pediatric Diabetes

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Introduction. The underlying pathophysiology of diabetes mellitus after acute pancreatitis is unknown and overall risk of developing diabetes postacute pancreatitis in children is understudied. The objective of our study was to describe the frequency of islet cell autoimmunity and abnormal glucose testing in pediatric patients in the year following their index case of acute pancreatitis. Materials and Methods. Data were obtained from a single-center observational cohort study of patients with their first episode of acute pancreatitis. Islet cell autoantibody titers were measured on stored plasma collected from acute pancreatitis diagnosis, at 3 months and at 12 months postacute pancreatitis attack. Abnormal glucose testing was defined as the presence of prediabetes or diabetes, as defined by American Diabetes Association criteria. Results. Eighty-four patients with acute pancreatitis and islet cell autoantibody data were included, 71 had available glucose measures. Median age at first acute pancreatitis attack was 14 years (IQR 8.7–16.3) and 45/84 (54%) were females. Twenty-four patients (29%) were positive for at least one of four islet cell autoantibodies (IAA, GADA, IA-2A, and ZnT8A) and 6 (7%) had two or more positive islet cell autoantibodies. Nineteen patients out of 71 (27%) had abnormal glucose testing at or postacute pancreatitis diagnosis. A higher proportion (37%, 7/19) with abnormal glucose testing had severe acute pancreatitis compared to those with normal glucose testing (13%, 7/52) ( p = 0.04 ). Patients with normal glucose testing were more likely to be positive for one or more islet cell autoantibodies (31%, 16/52) compared to those with abnormal glucose testing (0%, 0/19) ( p = 0.004 ). Conclusions. Islet cell autoimmunity is more common in children after their index acute pancreatitis attack (29%) than in the general population (7%–8%). While the frequency of prediabetes and diabetes postacute pancreatitis is high, other mechanisms besides islet cell autoimmunity are responsible.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

High Rate of Islets Autoimmunity in Pediatric Patients with Index Admission of Acute Pancreatitis

Tatum,

Hornung,

Bellin

et al. 2023

Pediatric Diabetes

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“…Similarly, only a statistically non-significant tendency could be observed in case of any organ failure (regardless of organ and duration of impairment) and DM [OR: 3.19; CI: 0.55–18.64; ( 36 , 40 , 45 , 52 )] or PD/DM [OR: 2.14; CI: 0.51–9.06; ( 31 , 32 , 46 ); Figure 4 ].…”

Section: Resultsmentioning

confidence: 99%

“…We found a significantly greater odds of developing PD/DM with necrotizing AP [OR: 5.53; CI: 1.59-19.21; (22,31,(46)(47)(48)] and a statistically non-significant tendency with DM [OR: 3.09; CI: 0.98-9.72; (24,30,36,40,41,49,50)] compared to non-necrotizing AP (Figure 4). Sensitivity analysis revealed that leaving out Takeyama (24) from the analysis would lead to a statistically significant OR (4.17; CI: 2.08-8.37) of developing DM in AP patients who had necrosis compared to its absence (Supplementary Figure S28).…”

Section: Ap Severity and Complicationsmentioning

confidence: 91%

“…Having SAP or moderately severe AP was associated with a significantly greater odds of developing PD/DM [OR: 4.32; CI: 1.76-10.60; Figure 3A; (27)(28)(29)(30)(31)(32)(33)(34)] and DM [OR: 2.11; CI: 1.30-3.41; Figure 3C; (28,29,(35)(36)(37)(38)(39)(40)(41)] compared to mild disease. SAP was associated with significantly increased odds of developing PD/DM [OR: 3.13; CI: 1.60-6.11; Figure 3B; (18,22,23,27,28,30,31,33)] and DM [OR: 1.86; CI: 1.27-2.73; Figure 3D; (19-21, 24, 28, 35-37, 41-45)] compared to mild-or-moderate disease.…”

Section: Ap Severity and Complicationsmentioning

confidence: 99%

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Risk factors for diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis

Zahariev,

Bunduc,

Kovács

et al. 2024

Front. Med.

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IntroductionWithin 5 years of having acute pancreatitis (AP), approximately 20% of patients develop diabetes mellitus (DM), which later increases to approximately 40%. Some studies suggest that the prevalence of prediabetes (PD) and/or DM can grow as high as 59% over time. However, information on risk factors is limited. We aimed to identify risk factors for developing PD or DM following AP.MethodsWe systematically searched three databases up to 4 September 2023 extracting direct, within-study comparisons of risk factors on the rate of new-onset PD and DM in AP patients. When PD and DM event rates could not be separated, we reported results for this composite outcome as PD/DM. Meta-analysis was performed using the random-effects model to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).ResultsOf the 61 studies identified, 50 were included in the meta-analysis, covering 76,797 participants. The studies reported on 79 risk factors, and meta-analysis was feasible for 34 risk factor and outcome pairs. The odds of developing PD/DM was significantly higher after severe and moderately severe AP (OR: 4.32; CI: 1.76–10.60) than mild AP. Hypertriglyceridemic AP etiology (OR: 3.27; CI: 0.17–63.91) and pancreatic necrosis (OR: 5.53; CI: 1.59–19.21) were associated with a higher risk of developing PD/DM. Alcoholic AP etiology (OR: 1.82; CI: 1.09–3.04), organ failure (OR: 3.19; CI: 0.55–18.64), recurrent AP (OR: 1.89; CI: 0.95–3.77), obesity (OR: 1.85; CI: 1.43–2.38), chronic kidney disease (OR: 2.10; CI: 1.85–2.38), liver cirrhosis (OR: 2.48; CI: 0.18–34.25), and dyslipidemia (OR: 1.82; CI: 0.68–4.84) were associated with a higher risk of developing DM.DiscussionSevere and moderately severe AP, alcoholic and hypertriglyceridemic etiologies, pancreatic necrosis, organ failure, recurrent acute pancreatitis and comorbidities of obesity, chronic kidney disease liver disease, and dyslipidemia are associated with a higher risk of developing PD or DM.Systematic review registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42021281983.

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Editorial commentary on the Indian Journal of Gastroenterology—November–December 2022

Limdi

2022

Indian J Gastroenterol

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New-onset prediabetes, diabetes after acute pancreatitis: A prospective cohort study with 12-month follow-up

Cited by 7 publications

References 22 publications

High Rate of Islets Autoimmunity in Pediatric Patients with Index Admission of Acute Pancreatitis

High Rate of Islets Autoimmunity in Pediatric Patients with Index Admission of Acute Pancreatitis

Risk factors for diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis

Editorial commentary on the Indian Journal of Gastroenterology—November–December 2022

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