Søren S Olesen1,2, Jakob L Poulsen1,2, Srdan Novovic3, Camilla Nøjgaard3, Evangelos Kalaitzakis4, Nanna M Jensen5, Trond Engjom6,7, Erling Tjora8,9, Anne Waage10, Truls Hauge11,12, Stephan L Haas13, Miroslav Vujasinovic13, Giedrius Barauskas14, Aldis Pukitis15, Imanta Ozola-Zālīte15, Alexey Okhlobystin16, Mikael Parhiala17,18, Johanna Laukkarinen17,18, Asbjørn M Drewes1,2. 1. Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark. 2. Clinical Institute, Aalborg University, Aalborg, Denmark. 3. Gastrounit, Hvidovre University Hospital, Hvidovre, Denmark. 4. Copenhagen University Hospital/Herlev, Copenhagen, Denmark. 5. Abdominalcenter K, Bispebjerg Hospital, Copenhagen, Denmark. 6. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 7. Department of Medicine, Haukeland University Hospital, Bergen, Norway. 8. Pediatric Department, Haukeland University Hospital, Bergen, Norway. 9. Center for Diabetes Research, University of Bergen, Bergen, Norway. 10. Department of Surgery, Oslo University Hospital, Oslo, Norway. 11. Department of Gastroenterology, Oslo University Hospital, Oslo, Norway. 12. Faculty of Medicine, University of Oslo, Oslo, Norway. 13. Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. 14. Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. 15. Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia. 16. Chair of Internal Diseases Propedeutics, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. 17. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. 18. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Abstract
BACKGROUND: Diabetes mellitus is a common complication of chronic pancreatitis. It is traditionally considered to develop as a consequence of beta cell loss, but there might be additional factors. Recent studies have highlighted the importance of type 2 diabetes-related risk factors in this context and population-based studies show increased risk of diabetes following acute pancreatitis. The aim of this study was to explore multiple risk factors for diabetes in patients with chronic pancreatitis. METHODS: We conducted a multicentre, cross-sectional study of patients with definitive chronic pancreatitis according to the M-ANNHEIM criteria. We used multivariable logistic regression models to determine risk factors independently associated with diabetes. RESULTS: The study included 1117 patients of whom 457 (40.9 %) had diabetes. The mean age was 52.8 ± 14.2 years and 67% were men. On multivariate analysis, parameters indicative of beta cell loss (pancreatic calcification, exocrine insufficiency, pancreatic resection) were confirmed as independent risk factors for diabetes (all p ≤ 0.02). In addition, type 2 diabetes-related risk factors (dyslipidaemia and overweight/obesity) were associated with the presence of diabetes (all p ≤ 0.002). Patients with a history of pancreatic fluid collections (indicative of previous attacks of acute pancreatitis) had a marginally increased risk of diabetes (p = 0.07). CONCLUSION: In patients with chronic pancreatitis the presence of diabetes is associated with multiple risk factors including type 2 diabetes-related factors. Our observations attest to the understanding of this entity and may have implications for treatment.
BACKGROUND:Diabetes mellitus is a common complication of chronic pancreatitis. It is traditionally considered to develop as a consequence of beta cell loss, but there might be additional factors. Recent studies have highlighted the importance of type 2 diabetes-related risk factors in this context and population-based studies show increased risk of diabetes following acute pancreatitis. The aim of this study was to explore multiple risk factors for diabetes in patients with chronic pancreatitis. METHODS: We conducted a multicentre, cross-sectional study of patients with definitive chronic pancreatitis according to the M-ANNHEIM criteria. We used multivariable logistic regression models to determine risk factors independently associated with diabetes. RESULTS: The study included 1117 patients of whom 457 (40.9 %) had diabetes. The mean age was 52.8 ± 14.2 years and 67% were men. On multivariate analysis, parameters indicative of beta cell loss (pancreatic calcification, exocrine insufficiency, pancreatic resection) were confirmed as independent risk factors for diabetes (all p ≤ 0.02). In addition, type 2 diabetes-related risk factors (dyslipidaemia and overweight/obesity) were associated with the presence of diabetes (all p ≤ 0.002). Patients with a history of pancreatic fluid collections (indicative of previous attacks of acute pancreatitis) had a marginally increased risk of diabetes (p = 0.07). CONCLUSION: In patients with chronic pancreatitis the presence of diabetes is associated with multiple risk factors including type 2 diabetes-related factors. Our observations attest to the understanding of this entity and may have implications for treatment.
Authors: Søren S Olesen; Camilla Nøjgaard; Jakob L Poulsen; Stephan L Haas; Miroslav Vujasinovic; Matthias Löhr; Björn Lindkvist; Louise Bexander; Antanas Gulbinas; Evangelos Kalaitzakis; Mohamed Ebrahim; Friedemann Erchinger; Trond Engjom; Stine Roug; Srdan Novovic; Truls Hauge; Anne Waage; Johanna Laukkarinen; Mikael Parhiala; Aldis Pukitis; Imanta Ozola-Zālīte; Asbjørn M Drewes Journal: Am J Gastroenterol Date: 2019-04 Impact factor: 10.864
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