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.
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.
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).
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: firstname.lastname@example.org
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.