Childhood Pancreatitis and Risk for Incident Diabetes in Adu
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Diabetes occurs when the pancreas is unable to secrete sufficient insulin to maintain normal glycemia due to autoimmune inflammation, nonautoimmune inflammation, infiltration, neoplasia, resection, or unknown causes. Whereas chronic pancreatitis was linked to a higher risk for diabetes, acute pancreatitis may be accompanied by transient hyperglycemia, but resolves in most patients without additional recognized sequelae. Nevertheless,a sequela of b-cell damage that is accompanied with an increased risk for diabetes later in life may be underappreciated. This possibility is becoming of growing clinical importance given a five fold increase in the cases of acute pancreatitis diagnosed during childhood and adolescence in the past two decades, approaching the incidence in adults, that had been primarily attributed to greater awareness among clinicians.

A nationwide, population-based study of 1,802,110 Israeli adolescents (mean age 17.4 years) who were examined before compulsory military service between 1979 and 2008 and whose data were linked to the Israeli National Diabetes Registry (INDR). Resolved pancreatitis was defined as a history of a single event of acute pancreatitis with normal pancreatic function at enrollment. Logistic regression analysis was applied.

Results: Incident diabetes developed in 4.6% of subjects with resolved pancreatitis and 2.5% among the unexposed group. Resolved acute pancreatitis was associated with incident diabetes with an odds ratio (OR) of 2.23 with adjustment for age, sex, and birth year. Findings persisted after further adjustments for baseline BMI and sociodemographic confounders. Childhood pancreatitis was associated with a diagnosis of diabetes at a younger age, with 92% of diabetes case subjects diagnosed before 40 years of age compared with 47% in the unexposed group (P = 0.002). The association accentuated when the study sample was limited to individuals of unimpaired health or normal BMI at baseline.

Conclusively, In conclusion, a clinically resolved single event of acute pancreatitis is associated with an increased risk for diabetes at young adulthood, independent of adolescent obesity or sociodemographic factors, and is associated with a younger age of disease diagnosis. These patients therefore may require a tighter follow-up and aggressive control of other diabetes risk factors. Future studies are required to confirm these results in other populations and test the role of early therapeutic intervention at the prediabetes. stage to prevent or delay diabetes onset.