A diagnosis of diabetes following pancreatic disease is often classified as type 2 diabetes but presents with worse glycemic control and a higher need for insulin, according to findings published in Diabetes Care.
Simon de Lusignan, MD, MBBS, MSc, of the department of clinical and experimental medicine, University of Surrey in Guildford, Surrey, United Kingdom, and colleagues evaluated data from primary care records in England on 2,360,631 adults to determine the incidence of diabetes after pancreatic disease, to explore how clinicians classify patients and to compare the clinical characteristics of type 1 and type 2 diabetes. Records were evaluated from Jan. 1, 2005, to March 21, 2016.
Overall, there were 31,789 new diabetes diagnoses with 559 diagnosed after pancreatic disease. Participants with diabetes following pancreatic disease were further divided into two groups: diabetes after acute pancreatitis (n = 361) and diabetes after chronic pancreatic disease (n = 198). Follow-up was a median of 4.5 years from the date of diabetes diagnosis.
Incidence of adult-onset diabetes after pancreatic disease was higher compared with incidence of adult-onset type 1 diabetes (2.59 per 1,000 person-years vs. 1.64 per 1,000 person-years; P < .001); however, the highest incidence was found for adult-onset type 2 diabetes (142.89 per 1,000 person-years).
Diabetes of the exocrine pancreas was rarely used to classify diabetes after pancreatic disease (2.7%), which was most commonly classified as type 2 diabetes (87.8%).
At 1 year following diagnosis, poor glycemic control was more common in participants with diabetes after pancreatic disease compared with those with type 2 diabetes (40.3% vs. 32.5%; P < .001).
At 5 years, insulin use was most common in participants with diabetes after chronic pancreatic disease (45.8%), followed by diabetes after acute pancreatitis (20.9%) and type 2 diabetes (4.1%).
“Clinicians should elicit whether a patient has any history of pancreatic disease when they first present with diabetes and consider the diagnosis of diabetes of the exocrine pancreas,” the researchers wrote. “Diabetes of the exocrine pancreas must be appropriately recognized to tailor management, including choice of antihyperglycemic therapy and consideration of malabsorption requiring pancreatic enzyme and vitamin D prescription. Greater awareness of diabetes of the exocrine pancreas is required to appropriately manage this diabetes subgroup.” – by Amber Cox
Disclosures: de Lusignan reports he heads a diabetes Real World Evidence Centre funded by Eli Lilly and received a research grant from AstraZeneca. Please see the study for all other authors’ relevant financial disclosures.