Chronic pancreatitis in diabetes raises risk for hyperglycemia crisis, hypoglycemia
Click Here to Manage Email Alerts
Chronic pancreatitis in the setting of diabetes further increases risks for serious complications, such as diabetic ketoacidosis, hyperglycemic hyperosmolar state and hypoglycemia, according to findings from a Taiwanese database analysis published in The Journal of Clinical Endocrinology & Metabolism.
“People with diabetes with chronic pancreatitis were found to have 9.5-fold, fivefold and threefold higher risks for DKA, hyperglycemic hyperosmolar state and hypoglycemia, respectively,” Chih-Chiang Chien, MD, associate professor and attending physician in the department of nephrology at Chi-Mei Medical Center in Tainan, Taiwan, told Healio. “People with diabetes would be well advised to avoid alcohol, receive early treatment for biliary tract disease, and have lipid profile monitored regularly to avoid chronic pancreatitis occurrence. Furthermore, more attention is needed for preventing hyperglycemia crisis and hypoglycemia prevention among people with diabetes who already have chronic pancreatitis.”
In a population-based study, Chien and colleagues analyzed data from 506 adults with diabetes and newly diagnosed chronic pancreatitis between 1999 and 2010, identified from Taiwan’s National Health Insurance Research Database. Researchers created a control cohort of 5,060 age- and sex-matched adults with diabetes but without chronic pancreatitis from the same period, followed from index date to occurrence of outcomes, death or Dec. 31, 2012. Main outcome measures were DKA, hyperglycemic hyperosmolar state, hypoglycemia and mortality.
Higher risks for complications
Comparing the two cohorts, researchers found that adults with diabetes and chronic pancreatitis were more likely to be men, younger and have more comorbidities compared with those with diabetes but without chronic pancreatitis.
The 1-, 5- and 10-year cumulative proportions of DKA were 2.2%, 11.1% and 14.4%, respectively, among those with diabetes and chronic pancreatitis, and 0.3%, 1.1% and 1.8% among controls. For hyperglycemic hyperosmolar state, 1-, 5- and 10-year cumulative proportions were 1.2%, 5.3% and 7.1%, respectively, among those with diabetes and chronic pancreatitis, and 0.2%, 0.7% and 1.1% among controls. For hypoglycemia, 1-, 5- and 10-year cumulative proportions were 2.4%, 10.5% and 21.1%, respectively, among those with diabetes and chronic pancreatitis, and 0.7%, 3.1% and 5.6% among controls.
Researchers found that adults with diabetes and chronic pancreatitis had a 9.5-fold higher risk for DKA (95% CI, 6.51-13.91), a 4.96-fold higher risk for hyperglycemic hyperosmolar state (95% CI, 2.85-8.62) and a 3.02-fold higher risk for hypoglycemia (95% CI, 2.23-4.08), compared with adults with diabetes but without chronic pancreatitis.
All-cause mortality
Adults with chronic pancreatitis had an all-cause mortality incidence of 23.88 per 1,000 person-years; controls had an all-cause mortality incidence of 6.87 per 1,000 patient-years. Those with chronic pancreatitis had a 2.43-fold higher risk for death (95% CI, 1.82-3.27) compared with those without chronic pancreatitis, after adjustment for other comorbidities.
“Our study found that diabetes patients with chronic pancreatitis are at increased risk of diabetes emergencies, including DKA, hyperglycemic hyperosmolar state, hypoglycemia and mortality,” the researchers wrote. “We studied the associations, and further study is needed to establish cause. In addition, more attention is needed to more closely monitor glucose and the use of antidiabetic medications in this population.” – by Regina Schaffer
For more information:
Chih-Chiang Chien, MD, can be reached at Chi-Mei Medical Center, 901 Jung-Hua Road, Yung Kang District, Tainan City 710, Taiwan; email: ccchien58@yahoo.com.tw.
Disclosures: The authors report no relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts