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Prediabetes, diabetes common after acute pancreatitis
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Patients with acute pancreatitis are at increased risk for developing prediabetes and/or diabetes after their initial attack, according to a recent study.
Researchers performed a systematic review and meta-analysis of 24 prospective clinical trials, including 1,102 adult patients with acute pancreatitis (AP), collected from searchers of Scopus, EMBASE and MEDLINE. All studies included patient follow-ups of 1 month or longer after hospital discharge. Incidence of prediabetes, diabetes and diabetes treated with insulin was assessed in each study. No publication bias was observed; study quality was rated high on the Newcastle-Ottawa Scale in 75% of cases.
Across 15 studies and among 628 evaluated patients, hyperglycemia occurred in 37% of cases, with moderate heterogeneity observed (I2=70%). Prediabetes was reported in 11 studies of 462 patients, with a pooled prevalence of 16%, with heterogeneity observed (I2=78%). Risk for prediabetes decreased initially after 12 months of follow-up (RR=0.44; 95% CI, 0.19-0.98 for 12 to 36 months), then stabilized over time.
New diagnoses of diabetes were reported in 20 studies of 936 patients, with a pooled prevalence of 23% and significant heterogeneity (I2=87%). Risk for diabetes increased significantly at 5 years post-AP attack (RR=2.66; 95% CI, 1.86-3.8)
Ten studies of 359 patients reported diabetes treated with insulin following an initial AP episode. Investigators calculated a pooled prevalence of 15%, with moderate heterogeneity (I2=64%). Risk for insulin-treated diabetes was significantly higher at 5 years post-AP compared with the first 12 months (RR=2.3; 95% CI, 0.97-5.4).
Meta-regression analysis indicated no significant impact on diabetes-related outcomes from AP severity and etiology and patient age and sex.
“This is the first study to systematically review all available evidence on burden of newly diagnosed hyperglycemia in general, and DM in particular, among patients after the first episode of AP,” the researchers wrote. “This … review indicates that patients with AP have a nearly 40% prevalence of newly diagnosed prediabetes or DM after discharge from hospital, and the risk of DM doubles over 5 years. Therefore, a formal follow-up of patients after AP may be more important than has been appreciated.”
Disclosure: The researchers report no relevant financial disclosures.
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