| Literature DB >> 19208917 |
Rebecca A Noel1, Daniel K Braun, Ruth E Patterson, Gary L Bloomgren.
Abstract
OBJECTIVE: The objective of this study was to assess the risk of acute pancreatitis in patients with type 2 diabetes compared with that in patients without diabetes. We also examined the risk of biliary disease (defined as occurrence of cholelithiasis, acute cholecystitis, or cholecystectomy), which is a major cause of pancreatitis. RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study using a large, geographically diverse U.S. health care claims database. Eligible patients (>or=18 years) were enrolled for at least 12 continuous months (1999-2005), with no incident events of pancreatitis or biliary disease during that 1 year baseline period. ICD-9 codes and prescription data were used to identify patients with type 2 diabetes; ICD-9 codes were also used to identify cases of pancreatitis and biliary disease. Overall, 337,067 patients with type 2 diabetes were matched on age and sex with 337,067 patients without diabetes. Incidence rates of disease and 95% CI were calculated per 100,000 person-years of exposure.Entities:
Mesh:
Year: 2009 PMID: 19208917 PMCID: PMC2671118 DOI: 10.2337/dc08-1755
Source DB: PubMed Journal: Diabetes Care ISSN: 0149-5992 Impact factor: 17.152
Patient selection criteria for a retrospective claims database study of the risk of pancreatitis or biliary disease associated with type 2 diabetes
| Patients remaining | Patients removed | |
|---|---|---|
| Enrolled in health plan at any time from 1 January 1999 through 31 December 2005 | 29,332,477 | — |
| Total population aged ≥18 years as of 1 January 2000, continuous enrollment for ≥1 year from 1 January 1999 through 31 December 2005 | 12,210,809 | 17,121,668 |
| At least 30 days of continuous enrollment from the end of 1-year enrollment | 9,249,211 | 2,961,598 |
| Control cohort: patients without diabetes | ||
| No medical claims for diabetes (250.xx) during the study period | 8,579,024 | 670,187 |
| No claims for antidiabetes medication during study period | 8,521,490 | 57,534 |
| Sex is unknown | 8,519,558 | 1,932 |
| Any medical claims during the study period | 6,947,299 | 1,572,259 |
| Study cohort: type 2 diabetes | ||
| Claim for type 2 diabetes or antidiabetic medication at any time from 1 January 1999 through 31 December 2005 | 1,337,081 | — |
| Claim for type 2 diabetes or antidiabetes medication during the continuous enrollment period | 640,504 | 696,577 |
| Medical claim for type 2 diabetes (250.x0 or 250.x2) during the continuous enrollment period | 563,827 | 76,677 |
| Claim for antidiabetes medication during the continuous enrollment period | 463,046 | 100,781 |
| Medical claim for type 2 diabetes (250.x0 or 250.x2) AND a claim for an antidiabetes medication during 1 January 1999 through 31 December 2005 | 386,369 | 76,677 |
| Drop patients on insulin-only therapy AND claim for type 1 diabetes (250.x1 or 250.x3) | 352,633 | 33,736 |
| Sex is known | 352,569 | 64 |
| Matching | ||
| Pairs matched 1:1 by sex and age category | 352,569 | — |
| Pairs with available claims data | 337,067 | 15,502 |
Incidence of acute pancreatitis associated with type 2 diabetes stratified by age and sex from a retrospective claims database study, 2000–2005
| Nondiabetic cohort | Type 2 diabetic cohort | IRR: type 2 diabetic cohort vs. nondiabetic cohort (95% CI) | |||||||
|---|---|---|---|---|---|---|---|---|---|
|
| Incident cases | Person-years of follow-up | Incidence rate per 100,000 person-years (95% CI) |
| Incident cases | Person-years of follow-up | Incidence rate per 100,000 person-years (95% CI) | ||
| Overall age | 336,410 | 827 | 553,959.28 | 149.29 (139.11–159.46) | 334,930 | 2,551 | 604,684.35 | 421.87 (405.50–438.24) | 2.83 (2.61–3.06) |
| 18–30 years | 13,628 | 9 | 17,029.62 | 52.85 (18.32–87.38) | 13,553 | 81 | 19,780.12 | 409.50 (320.32–498.68) | 7.75 (3.89–15.43) |
| 31–44 years | 78,518 | 105 | 120,783.10 | 86.93 (70.30–103.56) | 78,051 | 584 | 132,996.11 | 439.11 (403.50–474.72) | 5.05 (4.10–6.22) |
| 45–54 years | 120,354 | 272 | 200,359.38 | 135.76 (119.62–151.89) | 119,823 | 862 | 217,352.86 | 396.59 (370.11–423.07) | 2.92 (2.55–3.35) |
| 55–64 years | 91,859 | 273 | 154,084.70 | 177.18 (156.16–198.19) | 91,526 | 723 | 167,069.73 | 432.75 (401.21–464.30) | 2.44 (2.13–2.81) |
| ≥65 years | 32,051 | 168 | 61,702.48 | 272.27 (231.10–313.45) | 31,977 | 301 | 67,485.52 | 446.02 (395.63–496.41) | 1.64 (1.36–1.98) |
| Sex | |||||||||
| Female | 148,868 | 370 | 242,728.54 | 152.43 (136.90–167.97) | 148,288 | 1058 | 267,658.93 | 395.28 (371.46–419.10) | 2.59 (2.30–2.92) |
| Male | 187,542 | 457 | 311,230.74 | 146.84 (133.37–160.30) | 186,642 | 1493 | 337,025.42 | 442.99 (420.52–465.46) | 3.02 (2.72–3.35) |
*Patients with events of acute pancreatitis (n = 594 from the nondiabetic cohort and n = 1,883 from the type 2 diabetic cohort) or chronic pancreatitis (n = 162 from the nondiabetic cohort and n = 656 from the type 2 diabetic cohort) during the 1-year baseline period were excluded from the numerator and the denominator. In addition, patients with chronic pancreatitis during follow-up were excluded (n = 26 from the nondiabetic cohort and n = 161 from the type 2 diabetic cohort). Note that some patients may have had more than one exclusionary event.
Incidence of biliary disease associated with type 2 diabetes stratified by age and sex from a retrospective claims database study, 2000–2005
| Nondiabetic cohort | Type 2 diabetic cohort | IRR: type 2 diabetic cohort vs. nondiabetic cohort (95% CI) | |||||||
|---|---|---|---|---|---|---|---|---|---|
|
| Incident cases | Person-years of follow-up | Incidence rate per 100,000 person-years (95% CI) |
| Incident cases | Person-years of follow-up | Incidence rate per 100,000 person-years (95% CI) | ||
| Overall age | 333,529 | 4,019 | 545,088.58 | 737.31 (714.52–760.11) | 330,742 | 8,322 | 589,693.44 | 1,411.24 (1,380.92–1,441.56) | 1.91 (1.84–1.99) |
| 18–30 years | 13,557 | 72 | 16,884.62 | 426.42 (327.92–524.92) | 13,354 | 309 | 19,217.66 | 1,607.90 (1,428.61–1,787.18) | 3.77 (2.92–4.87) |
| 31–44 years | 78,030 | 599 | 119,453.07 | 501.45 (461.29–541.61) | 77,222 | 1,574 | 130,181.10 | 1,209.08 (1,149.35–1,268.82) | 2.41 (2.19–2.65) |
| 45–54 years | 119,356 | 1,300 | 197,277.31 | 658.97 (623.15–694.79) | 118,355 | 2,839 | 212,090.87 | 1,338.58 (1,289.34–1,387.82) | 2.03 (1.90–2.17) |
| 55–64 years | 90,942 | 1,286 | 151,221.24 | 850.41 (803.93–896.89) | 90,335 | 2,357 | 162,847.33 | 1,447.37 (1,388.94–1,505.80) | 1.70 (1.59–1.82) |
| ≥65 years | 31,644 | 762 | 60,252.34 | 1,264.68 (1,174.88–1,354.48) | 31,476 | 1,243 | 65,356.48 | 1,901.88 (1,796.15–2,007.61) | 1.50 (1.37–1.65) |
| Sex | |||||||||
| Female | 147,073 | 2,179 | 237,325.48 | 918.15 (879.60–956.70) | 145,557 | 4,387 | 258,394.28 | 1,697.79 (1,647.55–1,748.03) | 1.85 (1.76–1.95) |
| Male | 186,456 | 1,840 | 307,763.11 | 597.86 (570.54–625.18) | 185,185 | 3,935 | 331,299.16 | 1,187.75 (1,150.64–1,224.86) | 1.99 (1.88–2.10) |
*Biliary disease was defined as occurrence of cholelithiasis, acute cholecystitis, or cholecystectomy. Patients with biliary disease (n = 2,911 from the nondiabetic cohort and n = 5,173 from the type 2 diabetic cohort) or chronic cholecystitis (n = 452 from the nondiabetic cohort and n = 890 from the type 2 diabetic cohort) during the 1-year baseline period were excluded from the numerator and the denominator. Note that some patients may have had more than one exclusionary event.