The risk of development of diabetes mellitus after acute pancreatitis and its relationship with prognostic factors

Objective: In the study, it is planned to determine the rate of those with type 2 diabetes among 513 patients with acute pancreatitis who were hospitalized and followed up in Ankara City Hospital Internal Medicine and Gastroenterology Clinic, and to determine the development of prediabetes or diabetes during the follow-up of patients who were not diagnosed with diabetes at the time of admission. In addition, while examining the relationship between age, gender, duration, etiology (biliary/non-biliary), involvement (edematous/necrotizing), BISAP score, NEU/LYM and CRP/Alb values in patients presenting with acute pancreatitis, and the development of prediabetes or diabetes in the post-discharge follow-up, it is aimed to determine whether there is a risk factor and predictive value in the development of diabetes after acute pancreatitis. Material and Methods: The study was designed retrospectively, and includes 513 patients with acute pancreatitis who were hospitalized and followed up in Ankara City Hospital Internal Medicine and Gastroenterology clinics between February 2019 and February 2021. Patients under 18 years of age, patients with type 1 diabetes mellitus and patients with active gastrointestinal malignancy were excluded from the study. The routine lymphocyte, neutrophil, glucose, CRP (c-reactive protein) and albumin values of the patients were recorded at the time of admission to hospital. In addition, BİSAP scores were calculated using their age, BUN values, Glasgow Coma Scale scores, pleural effusion and presence of SIRS. The consecutive fasting blood glucose values observed until August 2022 were documented in terms of the development of prediabetes and diabetes, and the relationship of this situation with other examined parameters was evaluated. The measured parameters of the patients were recorded retrospectively using the hospital information system and the e-Nabiz system of the Ministry of Health. Statistical analyzes were performed with the help of SPSS version 17.0 program. In the statistical analysis, p<0.05 value was accepted as statistically significant. Findings: A total of 513 patients, 254 (49.5%) men and 259 (50.5%) women, who were hospitalized and followed up with the diagnosis of acute pancreatitis, were vi included in the study. The mean age of the patients was 55.57±18.24 years. 219 patients (42.6%) were 60 years or older. According to BISAP scoring, 400 patients (78%) were evaluated as mild acute pancreatitis and 113 patients (22%) were evaluated as severe acute pancreatitis. Etiological examination revealed 147 patients (28.7%) with non-biliary acute pancreatitis and 366 patients (71.3%) with biliary acute pancreatitis. Diabetes was not diagnosed at the time of diagnosis of acute pancreatitis in 407 patients (79.3%). 106 patients (20.7%) also had diabetes at the time of diagnosis of acute pancreatitis, and these patients were not included in the comparisons with prognostic factors. When the consecutive fasting blood glucose values of 407 patients were scanned in the following period, it was observed that 173 patients (42.5%) met the diagnostic criteria for diabetes or prediabetes, and 234 patients (57.5%) had a normoglycemic course. When 407 patients were analyzed according to their gender, it was seen that 198 patients (48.6%) were male and 209 patients (51.4%) were female. Out of 407 patients, 21 (67.7%) of 31 patients with necrotizing pancreatitis developed prediabetes or diabetes, while 152 (40.4%) of 376 patients with edematous pancreatitis developed a normoglycemic course. The incidence of prediabetes or diabetes development in patients with necrotizing pancreatitis was found to be statistically significantly higher than those with edematous pancreatitis (p<0.05). When the BISAP scores of patients who developed prediabetes or diabetes and those with a normoglycemic course were compared, it was found that the BISAP score was statistically significantly higher in patients who developed prediabetes or diabetes compared to the normoglycemic group (p<0.001). In addition, age, gender, duration, etiology (biliary/non-biliary), NEU/LYM and CRP/Alb parameters of both groups were compared in terms of diabetes development, but no statistically significant relationship was found between them. Conclusion: As a result of our study, the incidence of prediabetes or diabetes development in patients with acute necrotizing pancreatitis was found to be statistically significantly higher than those with edematous pancreatitis (p<0.05). BISAP scores of patients who developed prediabetes or diabetes were found to be statistically significantly higher when compared to the normoglycemic group (p<0.001). It has been concluded that close follow-up of patients with these risk factors in the post-acute pancreatitis period will enable early diagnosis of diabetes. Key Words: Acute Pancreatitis, Necrotizing Pancreatitis, Edematous Pancreatitis, Diabetes Mellitus, BISAP Score