Assessment of the relationship between attack severity and the risk of developing diabetes mellitus in patients with post-pancreatitis diabetes mellitus associated with acute pancreatitis

Introduction and Aim: Acute pancreatitis and diabetes mellitus are exocrine and endocrine diseases of the pancreas and are significant comorbidity causes in society. Our study aims to evaluate the relationship between the severity of acute pancreatitis attacks classified as mild, moderate, and severe according to the revised Atlanta criteria, and the risk of developing post-pancreatitis diabetes. Materials and Method: Medical records of patients aged 18 years and older hospitalized due to acute pancreatitis between 2012 and 2022 at the Department of Gastroenterology and Hepatology of Bezmialem Vakif University Hospital were retrospectively reviewed. Patients with known diabetes, chronic pancreatitis, recurring pancreatitis, those who had undergone pancreatic surgery, those developed pancreatic malignancies, and patients with incomplete data in their records were excluded from the evaluation. A total of 252 patients were included in the study. Routine blood tests of the patient performed during hospital admission were recorded. Evaluations were made based on the revised Atlanta classification using posterior-anterior chest X-rays, computed thoracic and abdominal tomography, clinical course notes, physical examination and medical history notes, and laboratory tests in terms of developed complications and organ failures. Patients were compared according to the severity of attacks based on the revised Atlanta classification, considering prediabetes or overt diabetes developed or not developed at least 1 year after the attack, based on HbA1c values checked after the attack. Additional risk factors such as smoking and alcohol use, presence of hypertension, age, gender, family history of diabetes, body mass index, and length of hospital stay were also taken into consideration. Findings: Our study included 252 patients, consisting of 164 females (65,1%) and 88 males (39,4%). The mean age in the study group was 58,07 ± 18,81 years, with the most frequent etiology identified as biliary (57,5%), and the second most common etiology as cryptogenic (32,5%). According to the revised Atlanta classification, 90 individuals (35,7%) were classified as having mild pancreatitis, 110 individuals (43,7%) as moderate, and 52 individuals (20,6%) as severe pancreatitis. It was determined that the probability of developing overt diabetes in patients classified as severe according to the revised Atlanta classification was significantly higher compared to those classified as moderate (p=0,001) and mild (p=0,025). Factors associated with an increased risk of overt diabetes were identified as higher age (p=0,021), family history of diabetes (p<0,001), classification as severe according to the revised Atlanta classification (p<0,001) and higher attack HbA1c values (p<0,001). When evaluating factors associated with prediabetes development using Cox regression analysis, the only associated factor determined was the HbA1c value measured during the attack (p=0,007). It was found that the risk of developing overt diabetes in patients classified as severe according to the revised Atlanta classification was 2,77 times higher (GA: 1,185-6,940, p=0,019) than in patients classified as mild. Conclusion: Diabetes is a disease that is increasingly prevalent in society, affecting many organs and systems. Identifying factors that increase the risk of diabetes is important for early diagnosis and management. In our study, it was observed that in patients who had experienced acute pancreatitis, there was an increased risk of developing diabetes, especially in those classified as severe according to the revised Atlanta classification. We believe that closely monitoring patients who have experienced acute pancreatitis, particularly those with severe attack, may aid in the early detection of diabetes. Keywords: Acute Pancreatitis, Diabetes Mellitus, Revised Atlanta Classification