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Patient and Disease Characteristics Associated With the Presence of Diabetes Mellitus in Adults With Chronic Pancreatitis in the United States

Bellin, Melena D MD, MS1; Whitcomb, David C MD, PhD2; Abberbock, Judah MS3; Sherman, Stuart MD4; Sandhu, Bimaljit S MD5; Gardner, Timothy B MD6; Anderson, Michelle A MD, MSc7; Lewis, Michele D MD8; Alkaade, Samer MD9; Singh, Vikesh K MD, MSc10; Baillie, John MD11; Banks, Peter A MD12; Conwell, Darwin MD, MS13; Cote, Gregory A MD14; Guda, Nalini M MD15; Muniraj, Thiruvengadam MD16; Tang, Gong PhD3; Brand, Randall E MD2; Gelrud, Andres MD17; Amann, Stephen T MD18; Forsmark, Christopher E MD19; Mel Wilcox, C MD20; Slivka, Adam MD, PhD2; Yadav, Dhiraj MD, MPH2

American Journal of Gastroenterology: September 2017 - Volume 112 - Issue 9 - p 1457–1465
doi: 10.1038/ajg.2017.181
ORIGINAL CONTRIBUTIONS: PANCREAS AND BILIARY TRACT
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Objectives: Diabetes mellitus (DM) is a common complication of chronic pancreatitis (CP). Past studies for DM risk factors in CP have been limited to single centers or highly focused on a single etiology such as alcoholic or hereditary disease. We studied risk factors for DM in a large population of patients with CP of all etiologies enrolled in the North American Pancreatitis 2 studies.

Methods: Participants (1,171) with CP (n=383 with DM,n=788 without DM) were enrolled prospectively from 26 participating centers. Questionnaires were completed by patients and physicians in a cross-sectional assessment. Patient demographics and disease characteristics were compared for CP with DM vs. without DM. Logistic regression was performed to assess the variables associated with DM diagnosis in a multivariable model.

Results: Diabetics were more likely to be black (P=0.02), overweight, or obese (P<0.001), and with a family history of DM (P=0.0005). CP patients with DM were more likely to have pancreatic calcifications (63% vs. 54%,P=0.002), atrophy (44% vs. 32%,P<0.0001), and prior pancreas surgery (26.9% vs. 16.9%,P<0.0001). In multivariate logistic regression modeling, the strongest risk factors for DM were obesity (odds ratio (OR) 2.8, 95% confidence interval (CI) 1.9, 4.2) and exocrine insufficiency (OR 2.4, 95% CI 1.8, 3.2).

Conclusions: In this large multicenter cohort of patients with CP, exocrine insufficiency, calcifications, and pancreas surgery conveyed higher odds of having DM. However, the traditional ‘type 2 DM’ risk factors of obesity and family history were similarly important in conveying risk for DM.

1Department of Pediatrics, University of Minnesota Medical Center and Masonic Children’s Hospital, Minneapolis, Minnesota, USA

2Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

3Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

4Department of Medicine, Indiana University, Indianapolis, Indiana, USA

5Richmond Gastroenterology Associates, Richmond, Virginia, USA

6Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA

7University of Michigan, Ann Arbor, Michigan, USA

8Mayo Clinic, Jacksonville, Florida, USA

9Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA

10Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

11Virginia Commonwealth University, Richmond, Virginia, USA

12Brigham and Women's Hospital, Boston, Massachusetts, USA

13Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA

14Medical University of South Carolina, Charleston, South Carolina, USA

15Aurora St. Luke’s Medical Center, Milwaukee, Wisconsin, USA

16Yale School of Medicine, New Haven, Connecticut, USA

17Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA

18Digestive Health Specialists, Tupelo, Mississippi, USA

19University of Florida, Gainesville, Florida, USA

20Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

Correspondence: Melena D. Bellin, MD, MS, University of Minnesota Medical Center and Masonic Children’s Hospital, East Building, Room MB-671, 2450 Riverside Avenue South, Minneapolis, Minnesota 55454, USA. E-mail: bell0130@umn.edu

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A554

Received 28 December 2016; accepted 24 April 2017

Guarantor of the article: Dhiraj Yadav, MD, MPH.

Specific author contributions: Study design: Melena D. Bellin, Judah N. Abberbock, Dhiraj Yadav, and David Whitcomb. Data acquisition: Stuart Sherman, Bimaljit S. Sandhu, Timothy B. Gardner, Michelle A. Anderson, Michele Lewis, Samer Alkaade, Vikesh K. Singh, John Baillie, Peter A. Banks, Darwin Conwell, Gregory A. Cote, Nalini M. Guda, Thiruvengadam Muniraj, Randall E. Brand, Andres Gelrud, Stephen Amann, Christopher E. Forsmark, Mel C. Wilcox, Adam Slivka, David Whitcomb, and Dhiraj Yadav. Statistical analysis: Judah N. Abberbock and Gong Tang. Drafting of the manuscript: Melena D. Bellin, Judah N. Abberbock, and Dhiraj Yadav. Data interpretation, review of manuscript for important intellectual content, final approval of the manuscript: all authors. Drs Whitcomb and Yadav co-directed this project.

Financial support: The study was supported by R01DK061451 (D.C.W.), R01 DK077906 (D.Y.), UO1 DK108306 (D.C.W. and D.Y.), UO1 DK 108327 (D.C), UO1 DK108320 (C.E.F.), and UL1 RR024153 and UL1TR000005 (P.I.—Steven E. Reis, MD).

Potential competing interest: Whitcomb is an inventor of intellectual property that is licensed to Ambry Genetics, which has been evaluated in this study. He also has an ownership interest in Ambry Genetics. All other authors have no conflicts of interest related to the manuscript.

© The American College of Gastroenterology 2017. All Rights Reserved.
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