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.
Bibliographical noteFunding Information:
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: Th e 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.