The risk factors that are known to increase the risk for type 2 diabetes are also associated with the development of diabetes in patients with chronic pancreatitis, according to the results of the PREDICT3c study published in the journal Diabetes Care.^1-4 Factors associated with the pancreatic disease were also identified as predictors of diabetes in these patients.

A team of researchers examined data of patients, aged 18-75 years, with chronic pancreatitis from the multicenter PROCEED (PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies) trial between June 2017 and August 2021. Out of the 645 selected participants, 276 were diabetic. Their objective was to determine the risk factors for the development of type 2 diabetes in this group of patients, who were categorized into three groups: Pre-pancreatitis diabetes group (diabetes diagnosed ≥1 year before pancreatitis diagnosis), concurrent diabetes group (diabetes diagnosed within 1 year of pancreatitis) and post-pancreatitis group (diabetes diagnosed ≥1 year after pancreatitis diagnosis).

The likelihood of developing diabetes was increased by at least 2-folds among men compared to women with odds ratio (OR) of 2.42. Overweight or obese patients were almost three times more likely to develop diabetes compared to participants with normal weight (OR 2.76). The risk was more than doubled among smokers (≥20 pack-years of cigarette smoking) vs nonsmokers (OR 2.08). Older adults were more at risk of diabetes; the risk increased by 3% with each year of life (OR 1.03). The risk of diabetes was 2-to 3-folds higher among patients of Hispanic (OR 3.16) and other (OR,2.33) ethnicities compared to the white race (OR 2.33-2.53).

Among the pancreas-related factors examined, a significant association was noted between diabetes and duration of pancreatitis, nonalcoholic causes of pancreatitis and history of acute pancreatitis complications. An association with type 2 diabetes was also noted for other pancreatic-disease related factors namely exocrine pancreatic dysfunction, pancreatic calcification and pancreatic atrophy. Type 2 diabetes risk factors were predominant in pre-pancreatitis diabetes, while pancreatic disease-related factors were predominant in patients with post-pancreatitis diabetes.

Patients with chronic pancreatitis are prone to develop diabetes, called pancreatogenic or type 3c diabetes. This diabetes is brittle and not easy to manage. It is more likely to become insulin dependent than type 2 diabetes. The associated morbidity and mortality is high. The pancreatic exocrine insufficiency, in addition to the endocrine insufficiency, results in malabsorption and nutritional deficiencies.⁵

This study has identified the factors that are predictive of diabetes in patients with chronic pancreatitis. It is therefore possible to clinically identify at-risk patients. Close monitoring of the high risk patients with chronic pancreatitis “who do not yet have diabetes” will help prevent future diabetes.

References

1. Jeon C, et al. Development of a clinical prediction model for diabetes in chronic pancreatitis: The PREDICT3c study. Diabetes Care. 2022 Nov 16;dc221414. doi: 10.2337/dc22-1414.
2. Study: Which people with chronic pancreatitis will develop diabetes? Nov16, 2022. Available at: https://www.cedars-sinai.org/newsroom/study-which-people-with-chronic-pancreatitis-will-develop-diabetes, Accessed Dec. 2, 2022.
3. https://www.healio.com/news/endocrinology/20221128/predict3c-study-highlights-risk-factors-for-diabetes-development-in-chronic-pancreatitis, November 29, 2022. Accessed Dec. 2, 2022.
4. https://www.ajmc.com/view/multiple-factors-associated-with-diabetes-in-patients-with-chronic-pancreatitis, November 28, 2022. Accessed Dec. 2, 2022.
5. Johnston PC, et al. Diabetes and chronic pancreatitis: considerations in the holistic management of an often neglected disease. J Diabetes Res. 2019 Oct 7;2019:2487804. doi: 10.1155/2019/2487804.