Chronic Pancreatitis and Diabetes Study

USA: Patients with chronic pancreatitis (CP) who use alcohol and are younger are at greater risk of having early-onset diabetes and poorer blood sugar control versus other CP patients, a recent study in Digestive Diseases and Sciences has revealed.

"Patients who develop diabetes following CP diagnosis have worse outcomes and utilize more resources," the researchers wrote in their study.

During the disease course of chronic pancreatitis, diabetes may develop secondary to endocrine insufficiency at any time. Shaharyar A. Zuberi, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA, and colleagues aimed to evaluate the differences in outcomes and clinical characteristics in CP patients having early-onset, late-onset diabetes, and pre-existing diabetes.

For this purpose, the researchers reviewed CP patients seen at a Pancreas Center during 2016–2021. They were divided into four groups: those without diabetes, with early-onset diabetes, with late-onset diabetes, and with pre-existing diabetes. Clinical characteristics and outcomes were then compared.

Study Findings

• The authors identified 450 patients with CP: 271 without diabetes, 99 with pre-existing diabetes, 51 with early-onset diabetes, and 29 with late-onset diabetes.
• Early-onset diabetics were younger (54.1 vs. 57.3 vs. 62.5 vs. 61.9 years), had more alcohol-related CP (45.1% vs. 31.7% vs. 32.3% vs. 31%), had higher HbA1C levels (8.02% vs. 5.11% vs. 7.71% vs. 7.66%), were more likely to be on insulin (78.4% vs. 0% vs. 48.4% vs. 65.5%), and used more opioids (64.7% vs. 43.9% vs. 55.1% vs. 44.8%) and gabapentinoids (66.7% vs. 43.5% vs. 48% vs. 60.7%) compared to other groups.
• Patients who developed diabetes after CP diagnosis had more exocrine insufficiency (72.4% vs. 70.6% vs. 65.7% vs. 53.1%), anatomical complications, and interventions for pain control.
• There was no difference in pancreatic cancer in the four groups.

"Chronic pancreatitis patients who are younger and drink alcohol are at higher risk of having early-onset diabetes and have poorer control of blood sugar compared to other CP patients," the researchers wrote. "Patients who develop diabetes following CP diagnosis have poor outcomes and use more resources."

About Chronic Pancreatitis

Chronic pancreatitis is characterized by pancreatic inflammation and fibrotic injury, causing irreversible parenchymal damage. Nutrient maldigestion and disturbance of the timing and the interactions between nutrient digestion and absorption are seen and may result in severe metabolic derangements. In the disease course, diabetes mellitus and glucose intolerance are observed quite frequently.

Diabetes development in chronic pancreatitis occurs mainly due to pancreatic inflammation destruction of islet cells.

Reference

Zuberi, S.A., Shah, I., Bocchino, R.L. et al. Pre-existing, Concurrent/Early-Onset, and Late-Onset Diabetes in Chronic Pancreatitis: Do Outcomes Differ?. Dig Dis Sci (2022). https://doi.org/10.1007/s10620-022-07742-y