Acute Pancreatitis in Childhood May Increase Risk for Type 2 Diabetes

Patients with a history of acute pancreatitis may require closer follow-up and control of diabetes risk factors in young adulthood.

A history of childhood acute pancreatitis that resolved without compromised pancreatic function may be associated with a 2-fold increased risk for type 2 diabetes and younger age at diabetes diagnosis, according to study results published in Diabetes Care.

As there are limited data on the association between a resolved single event of acute pancreatitis in childhood and the risk for diabetes later in life, the goal of the current study was to explore this association in a nationwide cohort of 1.8 million adolescents in Israel.

The study included all potential Israeli adolescents and young adults who underwent a medical examination at 16 to 20 years of age between January 1979 and December 2008 before compulsory military service. After the exclusion of patients with a history of diabetes or dysglycemia, missing height or weight data, or death before 2012, the final study cohort included 1,802,110 patients. Of these, 394 had a history of childhood pancreatic disease, including 281 with resolved pancreatitis and 113 with chronic pancreatic disease.

Of the 281 individuals with resolved pancreatitis, defined as a single event of acute pancreatitis at least 1 year before the study with normal pancreatic function at enrollment, 13 (4.63%) developed type 2 diabetes compared with 44,463 of 1,801,716 patients (2.47%) with no history of pancreatitis. The age-, sex-, and birth year-adjusted odds ratio was 2.23 (95% CI, 1.25-3.98) and the increased risk persisted after further adjustment for body mass index and sociodemographic confounders, with an odds ratio of 2.10 (95% CI, 1.15-3.84).

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Diagnosis of diabetes in patients with a history of resolved childhood pancreatitis was also at a significantly younger age compared with age at diagnosis in the unexposed group (36.4±4.8 vs 40.7±7.2 years; P =.037). Furthermore, 92% of patients with diabetes in the group with a history of childhood pancreatitis developed diabetes before 40 years of age compared with 47% of patients without a history of childhood pancreatitis (P =.002).

The risk for incident diabetes linked to resolved pancreatitis in childhood was accentuated when only individuals with normal body mass index were included (adjusted odds ratio, 3.09; 95% CI, 1.57-6.08).

The researchers noted that the study had several limitations, including missing data on the etiology and clinical severity of pancreatitis or recurrent events after military service, lifestyle data, and diabetes severity.

“[A] clinically resolved single event of acute pancreatitis is associated with an increased risk for diabetes at young adulthood, independent of adolescent obesity or sociodemographic factors, and is associated with a younger age of disease diagnosis,” concluded the researchers. “These patients therefore may require a tighter follow-up and aggressive control of other diabetes risk factors.”

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Bendor CD, Bardugo A, Zucker I, et al. Childhood pancreatitis and risk for incident diabetes in adulthood [published online November 6, 2019]. Diabetes Care. doi:10.2337/dc19-1562