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Diabetes Care, Volume 45, Issue 5 May 2022 | https://doi.org/10.2337/dc21-1659 Characteristics and Clinical Course of Diabetes of the Exocrine Pancreas: A Nationwide Population-Based Cohort Study

Nami Lee ¹, So Jeong Park ², Dongwoo Kang ², Ja Young Jeon ¹, Hae Jin Kim ¹, Dae Jung Kim ¹, Kwan-Woo Lee ¹, Edward J Boyko ³, Seung Jin Han ^1*

¹Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea.
²Data Science Team, Hanmi Pharmaceutical Co., Ltd, Seoul, South Korea.
³Veterans Affairs Puget Sound Health Care System, Seattle, WA.

^*Corresponding author.

Abstract

OBJECTIVE
The natural course of diabetes of the exocrine pancreas (DEP) is not well established. We aimed to compare the risk of insulin initiation, diabetic complications, and mortality between DEP and type 2 diabetes.

RESEARCH DESIGN AND METHODS
Using the Korean National Health Insurance Service–Health Screening Cohort between 2012 and 2017, we divided patients with diabetes into those with diabetes without prior pancreatic disease (indicated type 2 diabetes, n = 153,894) and diabetes with a prior diagnosis of pancreatic disease (indicated DEP, n = 3,629). ICD-10 codes and pharmacy prescription information were used to define type 2 diabetes, DEP, and acute and chronic diabetes complications. Kaplan-Meier curves were produced to compare insulin use over time between groups. We created logistic regression models for odds of progression to diabetic complications and mortality.

RESULTS
DEP was associated with a higher risk of insulin use than type 2 diabetes (adjusted hazard ratio 1.38 at 5 years [95% CI 1.30–1.47], P < 0.0001). Individuals with DEP showed higher risks of hypoglycemia (odds ratio 1.85 [1.54–2.21], P < 0.0001), diabetic neuropathy (1.38 [1.28–1.49], P < 0.0001), nephropathy (1.38 [1.27–1.50], P < 0.0001), retinopathy (1.10 [1.01–1.20], P = 0.0347), coronary heart disease (1.59 [1.48–1.70], P < 0.0001), cerebrovascular disease (1.38 [1.28–1.49], P < 0.0001), and peripheral arterial disease (1.34 [1.25–1.44], P < 0.0001). All-cause mortality was higher in those with DEP (1.74 [1.57–1.93], P < 0.0001) than in those with type 2 diabetes.

CONCLUSIONS
DEP is more likely to require insulin therapy than type 2 diabetes. Hypoglycemia, micro- and macrovascular complications, and all-cause mortality events are higher in DEP compared with type 2 diabetes.

논문정보

형식Research article
게재일2022년 05월 (BRIC 등록일 2022-05-20)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학

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