Risk factors for diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis

Olga Julia Zahariev; Stefania Bunduc; Adrienn Kovács; Dóra Demeter; Luca Havelda; Bettina Csilla Budai; Dániel Sándor Veres; Nóra Hosszúfalusi; Bálint Mihály Erőss; Brigitta Teutsch; Márk Félix Juhász; Péter Hegyi

doi:10.3389/fmed.2023.1257222

Risk factors for diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis

Front Med (Lausanne). 2024 Jan 9:10:1257222. doi: 10.3389/fmed.2023.1257222. eCollection 2023.

Authors

Olga Julia Zahariev^{1

2

3}, Stefania Bunduc^{1

4}, Adrienn Kovács^{1

5}, Dóra Demeter^{1

6}, Luca Havelda^{1

2}, Bettina Csilla Budai^{1

2}, Dániel Sándor Veres^{1

7}, Nóra Hosszúfalusi^{1

5}, Bálint Mihály Erőss^{1

2

3}, Brigitta Teutsch^{1

3}, Márk Félix Juhász^{3

8}, Péter Hegyi^{1

2

3

9}

Affiliations

¹ Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
² Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
³ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁴ Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
⁵ Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary.
⁶ Dietetic Services, Central Hospital of Northern Pest - Military Hospital, Budapest, Hungary.
⁷ Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
⁸ Heim Pál National Pediatric Institute, Budapest, Hungary.
⁹ Translational Pancreatology Research Group, Interdisciplinary Center of Excellence for Research Development and Innovation University of Szeged, Szeged, Hungary.

Abstract

Introduction: Within 5 years of having acute pancreatitis (AP), approximately 20% of patients develop diabetes mellitus (DM), which later increases to approximately 40%. Some studies suggest that the prevalence of prediabetes (PD) and/or DM can grow as high as 59% over time. However, information on risk factors is limited. We aimed to identify risk factors for developing PD or DM following AP.

Methods: We systematically searched three databases up to 4 September 2023 extracting direct, within-study comparisons of risk factors on the rate of new-onset PD and DM in AP patients. When PD and DM event rates could not be separated, we reported results for this composite outcome as PD/DM. Meta-analysis was performed using the random-effects model to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).

Results: Of the 61 studies identified, 50 were included in the meta-analysis, covering 76,797 participants. The studies reported on 79 risk factors, and meta-analysis was feasible for 34 risk factor and outcome pairs. The odds of developing PD/DM was significantly higher after severe and moderately severe AP (OR: 4.32; CI: 1.76-10.60) than mild AP. Hypertriglyceridemic AP etiology (OR: 3.27; CI: 0.17-63.91) and pancreatic necrosis (OR: 5.53; CI: 1.59-19.21) were associated with a higher risk of developing PD/DM. Alcoholic AP etiology (OR: 1.82; CI: 1.09-3.04), organ failure (OR: 3.19; CI: 0.55-18.64), recurrent AP (OR: 1.89; CI: 0.95-3.77), obesity (OR: 1.85; CI: 1.43-2.38), chronic kidney disease (OR: 2.10; CI: 1.85-2.38), liver cirrhosis (OR: 2.48; CI: 0.18-34.25), and dyslipidemia (OR: 1.82; CI: 0.68-4.84) were associated with a higher risk of developing DM.

Discussion: Severe and moderately severe AP, alcoholic and hypertriglyceridemic etiologies, pancreatic necrosis, organ failure, recurrent acute pancreatitis and comorbidities of obesity, chronic kidney disease liver disease, and dyslipidemia are associated with a higher risk of developing PD or DM.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021281983.

Keywords: acute pancreatitis (AP); diabetes mellitus; gastrointestinal disorders; pancreatitis—complications; prediabetes; risk factor (RF).

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The research was supported by the Hungarian Ministry of Innovation and Technology, National Research, Development and Innovation Fund (TKP2021-EGA-23 to PH), Translational Neuroscience National Laboratory program (RRF-2.3.1-21-2022-00011 to PH), a project grant (K131996 and K147265 to PH) and the Translational Medicine Foundation.