Glucose Variability During Early Course Of Acute Pancreatitis Can Predict New-Onset Of Diabetes

In a recent study, researchers reported that glucose variability (GV) during hospitalisation for acute pancreatitis accurately predicts future risk of developing deranged glucose metabolism, including new-onset diabetes after acute pancreatitis. The study findings were published in the United European Gastroenterology Journal on February 20, 2022.

Identification of high-risk individuals at the time of recovery from an attack of AP is of importance and it is one of the core elements of the 'holistic prevention of pancreatitis' framework. However, there is no accurate predictor at the time of hospitalisation for AP to identify individuals at high risk for new-onset diabetes. Therefore, Dr Maxim S. Petrov and his team conducted a first prospective longitudinal study to investigate the accuracy of indices of glucose variability (GV) during the early course of AP in predicting the glycated haemoglobin (HbA1c) trajectories during follow-up.

In a prospective longitudinal cohort study, the researchers included 120 patients without diabetes at the time of hospitalisation for AP. They measured the fasting blood glucose regularly over the first 72 h of hospital admission. End-points assessed were HbA1c trajectories - high-increasing, moderate-stable, normal-stable - over two years of follow-up. They evaluated the associations between several common GV indices and the HbA1c trajectories using multinomial logistic regression analyses. They further conducted a sensitivity analysis constrained to patients with non-necrotising AP.

Key findings of the study:

• Upon analysis, the researchers found that all patients in the high-increasing HbA1c trajectory group had new-onset diabetes at 18 and 24 months of follow-up.
• They noted that the glycaemic lability index had the strongest significant direct association (adjusted odds ratio = 13.69) with the high-increasing HbA1c trajectory.
• They found that high admission blood glucose, a standard deviation of blood glucose, and average real variability significantly increased the patients' odds of taking the high-increasing HbA1c trajectory by at least two times.
• They noted that all GV indices except for blood glucose had a significant direct association (adjusted odds ratio = 1.46; p = 0.034) with the moderate-stable HbA1c trajectory.
• They mentioned that the above findings did not change materially in patients with non-necrotising AP alone.

The authors concluded, "High GV during the early course of AP gives a prescient warning of worsening HbA1c pattern and new-onset diabetes after hospital discharge. Determining GV during hospitalisation could be a relatively straightforward approach to early identification of individuals at high risk for new-onset diabetes after AP".

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DOI: https://doi.org/10.1002/ueg2.12190