Comparison of clinical characteristics in acute pancreatitis with and without diabetes mellitus: a retrospective study

Background: Current research shows a cause-and-effect relationship between acute pancreatitis (AP) and diabetes mellitus (DM). In this study the difference in clinical features between AP with DM and AP without DM was analyzed to explore implications for the treatment of these two conditions.

Methods: From January 2016 to December 2018 all patients with AP admitted to the Changsha Central Hospital were included in a retrospective study. Clinical and laboratory variables obtained from AP patients were analyzed and compared with a DM group and a non-DM group.

Results: A total of 869 patients with AP including 139 patients in DM the group and 730 patients in the non-DM group were analyzed. Hypertension (P = 0.002), coronary heart disease (CHD, P = 0.003) and hypertriglyceridemia (P = 0.045) were more common in the DM than the non-DM group, while BISAP (P < 0.001) and Ranson (P < 0.001), the incidence of AP recurrence (P = 0.034) and length of hospital stay (P = 0.045) were significantly higher for the DM group as were levels of blood sugar (P < 0.001), glycated hemoglobin (P < 0.001), ALT (P = 0.003), AST (P = 0.032), BUN (P = 0.017), creatinine (P = 0.003), cholesterol (P < 0.001), LDL (P < 0.001) and TG (P < 0.001).

Conclusion: AP patients with DM were prone to comorbidities with higher levels of organ function indicators and higher incidence of dyslipidemia and recurrence of AP.

Acute pancreatitis; Diabetes mellitus; Comorbidity; Dyslipidemia

[1] Cho J, Scragg R, Petrov MS. Risk of Mortality and Hospitalization after Post-Pancreatitis Diabetes Mellitus vs Type 2 Diabetes Mellitus: a Population-Based Matched Cohort Study. American Journal of Gastroenterology. 2019; 114: 804-812.

[2] Yuanmei L, Qian Z, Fengsen X, Yankui W. Restricted gestational weight gain in overweight/obese women with gestational diabetes mellitus and pregnancy outcomes. Clinical and Experimental Obstetrics & Gynecology. 2019; 46: 763-769.

[3] Zhi M, Zhu X, Lugea A, Waldron RT, Pandol SJ, Li L. Incidence of new onset diabetes mellitus secondary to acute pancreatitis: a systematic review and meta-analysis. Frontiers in Physiology. 2020; 10: 637.

[4] Bellin MD, Lowe M, Zimmerman MB, Wilschanski M, Werlin S, Troendle DM, et al. Diabetes mellitus in children with acute recurrent and chronic pancreatitis: data from the international study group of pediatric pancreatitis: in search for a cure cohort. Journal of Pediatric Gastroenterology and Nutrition. 2019; 69: 599-606.

[5] Xie T, Hao L, Liu Y, Zhang D, Bi YW, Wang T, et al. Risk factor for diabetes mellitus in pediatric chronic pancreatitis patients. Medicine. 2019; 98: e17984.

[6] Li Q, Hou C, Peng Y, Zhu X, Shi C, Zhang K, et al. Diabetes and younger age are vital and independent risk factors for acute pancreatitis in patients with severe hypertriglyceridemia. BioMed Research International. 2019; 2019: 1-6.

[7] Aune D, Mahamat-Saleh Y, Norat T, Riboli E. Diabetes mellitus and the risk of pancreatitis: a systematic review and meta-analysis of cohort studies. Pancreatology. 2020; 20: 602-607.

[8] Xue M, Liu L, Wang S, Su Y, Lv K, Zhang M, et al. A simple nomogram score for screening patients with type 2 diabetes to detect those with hypertension: a cross-sectional study based on a large community survey in China. PLoS one. 2020; 15: e0236957.

[9] Zhang Y, Nie J, Zhang Y, Li J, Liang M, Wang G, et al. Degree of blood pressure control and incident diabetes mellitus in chinese adults with hypertension. Journal of the American Heart Association. 2020; 9: e017015.

[10] Găman MA, Cozma MA, Dobrică EC, Bacalbașa N, Bratu OG, Diaconu CC. Dyslipidemia: a trigger for coronary heart disease in romanian patients with diabetes. Metabolites. 2020; 10: 195.

[11] Kwon YH, Kim S, Cho JH, Kwon H, Park SE, Oh H, et al. The association between persistent hypertriglyceridemia and the risk of diabetes development: the kangbuk samsung health study. Endocrinology and Metabolism. 2018; 33: 55.

[12] Xiao B, Xu H, Jiang Z, Hu J, Yang G. Acute pancreatitis in patients with a medical history of type 2 diabetes mellitus. Pancreas. 2020; 49: 591-597.

[13] Singh S, Chang H, Richards TM, Weiner JP, Clark JM, Segal JB. Glucagonlike peptide 1-based therapies and risk of hospitalization for acute pancreatitis in type 2 diabetes mellitus: a population-based matched case-control study. JAMA Internal Medicine. 2013; 173: 534-539.

[14] Dunachie S, Chamnan P. The double burden of diabetes and global infection in low and middle-income countries. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2019; 113: 56-64.

[15] Zhang W, Shan H, Gu Y. Recurrent acute pancreatitis and its relative factors. World Journal of Gastroenterology. 2005; 11: 3002-3004.

[16] Guda NM, Muddana V, Whitcomb DC, Levy P, Garg P, Cote G, et al. Recurrent acute pancreatitis: international state-of-the-science conference with recommendations. Pancreas. 2018; 47: 653-666.

[17] Gullo L, Migliori M, Pezzilli R, Oláh A, Farkas G, Levy P, et al. An update on recurrent acute pancreatitis: data from five European countries. The American Journal of Gastroenterology. 2002; 97: 1959-1962.

[18] Shemesh E, Zafrir B. Hypertriglyceridemia-related pancreatitis in pa-tients with type 2 diabetes: links and risks. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2019; 12: 2041-2052.

[19] Zhang R, Deng L, Jin T, Zhu P, Shi N, Jiang K, et al. Hypertriglyceridaemia-associated acute pancreatitis: diagnosis and impact on severity. HPB. 2019; 21: 1240-1249.

[20] Cole JB, Florez JC. Genetics of diabetes mellitus and diabetes complica-tions. Nature Reviews Nephrology. 2020; 16: 377-390.

[21] Abro MUR, Butt A, Baqa K, Waris N, Khalaid M, Fawwad A. Association of serum liver enzyme Alanine Aminotransferase (ALT) in patients with type 2 diabetes. Pakistan Journal of Medical Sciences. 2018; 34: 839-843.

[22] Forlani G, Di Bonito P, Mannucci E, Capaldo B, Genovese S, Orrasch M, et al. Prevalence of elevated liver enzymes in Type 2 diabetes mellitus and its association with the metabolic syndrome. Journal of Endocrinological Investigation. 2008; 31: 146-152.

[23] Xie Y, Bowe B, Li T, Xian H, Yan Y, Al-Aly Z. Higher blood urea nitrogen is associated with increased risk of incident diabetes mellitus. Kidney International. 2018; 93: 741-752.

[24] Kim G, DeSalvo D, Guffey D, Minard CG, Cephus C, Moodie D, et al. Dyslipidemia in adolescents and young adults with type 1 and type 2 diabetes: a retrospective analysis. International Journal of Pediatric Endocrinology. 2020; 2020: 11.

[25] Shah N, Khadilkar A, Gondhalekar K, Khadilkar V. Prevalence of dyslipidemia in Indian children with poorly controlled type 1 diabetes mellitus. Pediatric Diabetes. 2020; 21: 987-994.

[26] Hossain M, Hosen Z, Kabir I, Karim MR, Rahim MA, Uddin KN. A comparative study on clinical features and outcomes of acute pancreatitis between diabetic and non-diabetic hospitalized patients. BIRDEM Medical Journal. 2020; 10: 172-181.

[27] Mitura K. The impact of COVID-19 pandemic on critical care and surgical services availability. Critical Care Innovations. 2020; 3: 43-50.