The Impact of Type Two Diabetes on Acute Pancreatitis Outcomes: A Nationwide Analysis

Abstract

Introduction: Type 2 diabetes (T2D) is associated with worse outcomes in various medical conditions. While some studies have shown an increased incidence of acute pancreatitis (AP) in patients with T2D due to higher incidence of cholelithiasis in patients with obesity, others have detected a paradoxical effect on mortality. The aim of this study was to further explore the impact of T2D on outcomes in AP. Methods: This was a retrospective cohort study using the 2013 National Inpatient Sample, the largest publically available inpatient database in the US. All patients with an ICD-9 CM code for a principal diagnosis of AP were included. There were no exclusion criteria. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity measured by intensive care unit (ICU) admission, shock and multi-organ failure, resource utilization measured by abdominal CT scan, abdominal ultrasound (US), total parenteral nutrition (TPN) use, length of hospital stay (LOS), and total hospitalization charges (THC). Patients were classified as having or not having T2D, stratified by organ failure, using ICD-9 CM codes. Using multivariate regression analysis, odds ratios and means were adjusted for: age; sex; race; median income in the patient's zip code; Charlson Comorbidity Index; hospital region; urban location; size and teaching status.Table 2Results: 257,405 patients with acute pancreatitis were included in the study, 77,365 (30%) of whom had a T2D. Mean age was 53 years and 44% were female. The overall mortality was 0.7% (0.9% in patients with T2D). On multivariate analysis, the odds of in-hospital mortality of patients with AP and T2D were less when compared to patients without T2D (OR:0.65, 95%CI:0.51-0.83,p < 0.01). Table 1 shows adjusted odds ratios, adjusted means and p-values. Looking at morbidity as measured by shock, need for ICU admission, and end-organ damage, there was no statistically significant difference between patients with T2D and AP as opposed to patients without diabetes. Also, no significant differences were found in terms of length of stay, THC, TPN or abdominal imaging use.Table 1Conclusion: For patients with a principal diagnosis of AP, the coincident diagnosis of T2D is associated with lesser in-hospital mortality rates compared to patients without T2D, which may suggest an effect of the known “obesity paradox”, as most patients with T2D are obese. T2D does not affect morbidity, inpatient resource utilization, THC or hospital LOS in patients with AP.