Chronic pancreatitis (CP) is associated with increased risk for diabetes-associated emergencies, including diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state, and hypoglycemia, as well as mortality, according to study results published in The Journal of Clinical Endocrinology & Metabolism.
Disruption of the normal physiology of the pancreas may lead to development of diabetes, and previous studies have reported that between 41% and 86% of patients with CP have concomitant diabetes. As CP is a severe inflammatory disease, it can cause severe complications and increases mortality risk. The goal of the current study was to explore the association between CP and acute complications in patients with diabetes.
Data from Taiwan’s National Health Insurance program were used for this study; the researchers established a case cohort that consisted of 506 adult patients with diabetes and CP and a control cohort of 5060 age- and sex-matched patients with diabetes who did not have CP. The main outcome measures included DKA, hyperglycemic hyperosmolar state, hypoglycemia, and mortality.
The incidence of DKA was 17.40 per 1000 patient-years in the case cohort compared with 1.87 per 1000 patient-years in the control cohort (adjusted hazard ratio [aHR], 9.51; 95% CI, 6.51-13.91; P <.001).
The incidence of hyperglycemic hyperosmolar state was 7.78 per 1000 patient-years in the case cohort and 1.21 per 1000 patient-years in the control individuals (aHR, 4.96, 95% CI, 2.85-8.62; P <.001).
Hypoglycemia risk was approximately 3-fold higher among patients with diabetes who had CP compared with those who did not, with incidences of 22.9 and 6.05 per 1000 patient-years, respectively (aHR, 3.02; 95% CI, 2.23-4.08; P <.001).
All-cause mortality incidence among patients in the case cohort was 23.88 per 1000 patient-years, whereas in the control cohort, the incidence was 6.87 per 1000 patient-years (aHR, 2.43; 95% CI, 1.82-3.27; P <.001).
The researchers acknowledged several limitations to their findings, including the study design, which precludes establishing a causal association. They also noted the possibility of confounding by indication and various lifestyle and behavior factors. Further limitation stemmed from the identification of comorbidities based on insurance claims, which may have led to misclassifications.
“[O]ur study found [patients with diabetes] with CP are at increased risk of [diabetes-related] emergencies, including DKA, [hyperglycemic hyperosmolar state], hypoglycemia and mortality,” the researchers stated. “[M]ore attention is needed to more closely monitor glucose and the use of anti-diabetic medications in [this] population.”
Lin CH, Yeh NC, Wang JJ, et al. Effect of chronic pancreatitis on complications and mortality in DM patients: a 10-year nationwide cohort study [published online January 24, 2020]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgaa035/5715202