Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis
- Stephanie L M Das1,
- Primal P Singh1,
- Anthony R J Phillips1,
- Rinki Murphy2,
- John A Windsor1,
- Maxim S Petrov1
- 1Department of Surgery, The University of Auckland, Auckland, New Zealand
- 2Department of Medicine, The University of Auckland, Auckland, New Zealand
- Correspondence to Dr Maxim S Petrov, Department of Surgery, The University of Auckland, Room 12.092, Level 12, Auckland City Hospital, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand;
- Received 11 April 2013
- Revised 2 July 2013
- Accepted 4 July 2013
- Published Online First 8 August 2013
Background Diabetes mellitus (DM) is common in the general population and it poses a heavy burden to society in the form of long-term disability, healthcare use and costs. The pancreas is a key player in glucose homeostasis, but the occurrence of newly diagnosed DM after acute pancreatitis (AP), the most frequent disease of the pancreas, has never been assessed systematically. The aim of this study was to conduct a systematic literature review to determine the prevalence and time course of DM and related conditions after the first attack of AP as well as the impact of covariates.
Methods Relevant literature cited in three electronic databases (Scopus, EMBASE and MEDLINE) was reviewed independently by two authors. The main outcome measures studied were newly diagnosed prediabetes, DM, or DM treated with insulin. Pooled prevalence and 95% CIs were calculated for all outcomes.
Results A total of 24 prospective clinical studies, involving 1102 patients with first episode of AP, met all the eligibility criteria. Prediabetes and/or DM was observed in 37% (95% CI 30% to 45%) individuals after AP. The pooled prevalence of prediabetes, DM and treatment with insulin after AP was 16% (95% CI 9% to 24%), 23% (95% CI 16% to 31%), and 15% (95% CI 9% to 21%), respectively. Newly diagnosed DM developed in 15% of individuals within 12 months after first episode of AP and the risk increased significantly at 5 years (relative risk 2.7 (95% CI 1.9 to 3.8)). A similar trend was observed with regard to treatment with insulin. The severity of AP, its aetiology, individuals’ age and gender had minimal effect on the studied outcomes.
Conclusions Patients with AP often develop prediabetes and/or DM after discharge from hospital, and have a greater than twofold increased risk of DM over 5 years. Further studies are warranted to determine the optimal strategy for its detection and whether the risk of developing DM after AP can be reduced.