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Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

New-onset diabetes is the most common sequela of acute pancreatitis (AP). Yet, prospective changes in glycaemia over time have never been investigated comprehensively in this study population. The primary aim was to determine the cumulative incidence of new-onset prediabetes and new-onset diabetes after AP over 24 months of follow-up in a prospective cohort study. The secondary aim was to identify trajectories of glycaemia during follow-up and their predictors at the time of hospitalisation.

Methods

Patients with a prospective diagnosis of AP and no diabetes based on the American Diabetes Association criteria were followed up every 6 months up to 24 months after hospital discharge. Incidence of new-onset prediabetes/diabetes over each follow-up period was calculated. Group-based trajectory modelling was used to identify common changes in glycaemia. Multinomial regression analyses were conducted to investigate the associations between a wide array of routinely available demographic, anthropometric, laboratory, imaging, and clinical factors and membership in the trajectory groups.

Results

A total of 152 patients without diabetes were followed up. The cumulative incidence of new-onset prediabetes and diabetes was 20% at 6 months after hospitalisation and 43% over 24 months of follow-up (p trend < 0.001). Three discrete trajectories of glycaemia were identified: normal-stable glycaemia (32%), moderate-stable glycaemia (60%), and high-increasing glycaemia (8%). Waist circumference was a significant predictor of moderate-stable glycaemia. None of the studied predictors were significantly associated with high-increasing glycaemia.

Conclusions

This first prospective cohort study of changes in glycaemia (determined at structured time points in unselected AP patients) showed that at least one out of five patients develops new-onset prediabetes or diabetes at 6 months of follow-up and more than four out of ten—in the first 2 years. Changes in glycaemia after AP follow three discrete trajectories. This may inform prevention or early detection of critical changes in blood glucose metabolism following an attack of AP and, hence, reduce the burden of new-onset diabetes after acute pancreatitis.

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Acknowledgements

This study was part of the COSMOS program. COSMOS is supported, in part, by the Health Research Council of New Zealand (grant 15/035 to Associate Professor Max Petrov), which played no role in the study design; collection, analysis, or interpretation of data, or writing of the manuscript.

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Authors and Affiliations

  1. School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand

    Sakina Huseni Bharmal, Jaelim Cho, Gisselle Charlott Alarcon Ramos, Juyeon Ko, Charlotte Elizabeth Stuart, Andre Eto Modesto, Ruma Girish Singh & Maxim Sergey Petrov

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  1. Sakina Huseni Bharmal
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Correspondence to Maxim Sergey Petrov.

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Bharmal, S.H., Cho, J., Alarcon Ramos, G.C. et al. Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up. J Gastroenterol 55, 775–788 (2020). https://doi.org/10.1007/s00535-020-01682-y

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