Samuel Oschin Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH.
Diabetes Care. 2023 Jan 1;46(1):46-55. doi: 10.2337/dc22-1414.
Diabetes that arises from chronic pancreatitis (CP) is associated with increased morbidity and mortality. Methods to predict which patients with CP are at greatest risk for diabetes are urgently needed. We aimed to examine independent risk factors for diabetes in a large cohort of patients with CP.
This cross-sectional study comprised 645 individuals with CP enrolled in the PROCEED study, of whom 276 had diabetes. We conducted univariable and multivariable regression analyses of potential risk factors for diabetes. Model performance was assessed by area under the receiver operating characteristic curve (AUROC) analysis, and accuracy was evaluated by cross validation. Exploratory analyses were stratified according to the timing of development of diabetes relative to the diagnosis of pancreatitis.
Independent correlates of diabetes in CP included risk factors for type 2 diabetes (older age, overweight/obese status, male sex, non-White race, tobacco use) as well as pancreatic disease-related factors (history of acute pancreatitis complications, nonalcoholic etiology of CP, exocrine pancreatic dysfunction, pancreatic calcification, pancreatic atrophy) (AUROC 0.745). Type 2 diabetes risk factors were predominant for diabetes occurring before pancreatitis, and pancreatic disease-related factors were predominant for diabetes occurring after pancreatitis.
Multiple factors are associated with diabetes in CP, including canonical risk factors for type 2 diabetes and features associated with pancreatitis severity. This study lays the groundwork for the future development of models integrating clinical and nonclinical data to identify patients with CP at risk for diabetes and identifies modifiable risk factors (obesity, smoking) on which to focus for diabetes prevention.
由慢性胰腺炎（CP）引起的糖尿病与发病率和死亡率增加有关。迫切需要找到预测哪些 CP 患者患糖尿病风险最大的方法。我们旨在研究 CP 患者的大型队列中糖尿病的独立危险因素。
这项横断面研究纳入了 PROCEED 研究中的 645 名 CP 患者，其中 276 名患有糖尿病。我们对糖尿病的潜在危险因素进行了单变量和多变量回归分析。通过接受者操作特征曲线下面积（AUROC）分析评估模型性能，并通过交叉验证评估准确性。根据糖尿病与胰腺炎诊断的时间关系进行了探索性分析。
CP 中糖尿病的独立相关因素包括 2 型糖尿病的危险因素（年龄较大、超重/肥胖、男性、非白种人、吸烟）以及与胰腺疾病相关的因素（急性胰腺炎并发症史、CP 的非酒精性病因、外分泌胰腺功能障碍、胰腺钙化、胰腺萎缩）（AUROC 为 0.745）。2 型糖尿病的危险因素主要与胰腺炎前发生的糖尿病有关，而与胰腺疾病相关的因素主要与胰腺炎后发生的糖尿病有关。
多种因素与 CP 中的糖尿病有关，包括 2 型糖尿病的典型危险因素和与胰腺炎严重程度相关的特征。本研究为未来开发整合临床和非临床数据的模型以识别 CP 患者中患糖尿病风险的患者奠定了基础，并确定了可改变的危险因素（肥胖、吸烟），可针对这些因素进行糖尿病预防。
