Risk Factor For Development Of Diabetes Mellitus Research Articles

Risk factors and nomogram for diabetes mellitus in idiopathic chronic pancreatitis.

Diabetes mellitus (DM) is a common complication of idiopathic chronic pancreatitis (ICP), which impairs the quality of life for patients. This study aimed to identify risk factors and develop nomogram for DM in ICP to help early diagnosis. Idiopathic chronic pancreatitis patients admitted to our center from January 2000 to December 2013 were included. Cumulative rates of DM were calculated by Kaplan-Meier method. Patients were randomly assigned, in a 2:1 ratio, to the training and validation cohort. Based on training cohort, risk factors for DM were identified through Cox proportional hazards regression model, and nomogram was developed. Internal and external validations were performed based on the training and validation cohort, respectively. Totally, 1633 patients with ICP were finally enrolled. The median follow-up duration was 9.8 years. DM was found in 26.3% (430/1633) of patients after the onset of CP. Adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct were identified risk factors for DM development. The nomogram achieved good concordance indexes in the training and validation cohorts, respectively, with well-fitted calibration curves. Risk factors were identified, and nomogram was developed to determine the risk of DM in ICP patients. Patients with one or more of the risk factors including adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct have higher incidence of DM.

Risk Factors for Diabetes Mellitus in Chronic Pancreatitis: A Cohort of 2,011 Patients.

Diabetes mellitus (DM) is a common complication of chronic pancreatitis (CP) and increases the mortality. The identification of risk factors for DM development may contribute to the early detection and potential risk reduction of DM in patients with CP.Patients with CP admitted to Changhai Hospital (Shanghai, China) from January 2000 to December 2013 were enrolled. Cumulative rates of DM after the onset of CP were calculated by Kaplan-Meier method. Risk factors for DM development after the diagnosis of CP were identified by Cox proportional hazards regression model.A total of 2011 patients with CP were enrolled. During follow-up (median duration, 22.0 years), 564 patients developed DM. Cumulative rates of DM 20 and 50 years after the onset of CP were 45.8% (95% confidence interval [CI], 41.8%–50.0%) and 90.0% (95% CI, 75.4%–97.7%), respectively. Five risk factors for DM development after the diagnosis of CP were identified: male sex (hazard ratio [HR], 1.51; 95% CI, 1.08–2.11), alcohol abuse (HR, 2.00; 95% CI, 1.43–2.79), steatorrhea (HR, 1.46; 95% CI, 1.01–2.11), biliary stricture (HR, 2.25; 95% CI, 1.43–3.52), and distal pancreatectomy (HR, 3.41; 95% CI, 1.80–6.44).In conclusion, the risk of developing DM in patients with CP is not only influenced by the development of biliary stricture and steatorrhea indicating disease progression, and inherent nature of study subjects such as male sex, but also by modifiable factors including alcohol abuse and distal pancreatectomy .

Abstract 9692: Lower Achieved Systolic Pressure (≤130 mm Hg) is Associated With a Decreased Risk of New Diabetes Mellitus in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study

Background: There is a well-established association between higher blood pressure (BP) and insulin resistance and hypertensive patients are at increased risk of developing diabetes mellitus (DM). Although lower achieved systolic BP (SBP) was not associated with reduced mortality or cardiovascular outcomes in diabetic hypertensives or in hypertensive patients with ECG left ventricular hypertrophy (LVH) in the LIFE study, whether more aggressive reduction of SBP is associated with a lower incidence of DM has not been examined. Methods: Risk of new-onset DM was examined in relation to last in-treatment SBP prior to DM diagnosis or last in-study measurement in the absence of new DM in 7485 hypertensive patients with ECG LVH with no history of DM randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141, were compared with patients with in-treatment SBP ≥142 (median SBP at last measurement). Results: During 4.6±1.2 years follow-up, new-onset DM was diagnosed in 520 patients (6.9%). In univariate analyses, compared with in-treatment SBP ≥142, in-treatment SBP ≤130 entered as a time-varying covariate was associated with a 57% lower risk (95% CI 39-69%) of new DM and in-treatment SBP between 131 and 141 with a 30% lower risk (95% CI 14-42%) of developing DM. After adjusting for randomized treatment, age, sex, race, prior antihypertensive therapy, baseline body mass index (BMI), uric acid, serum glucose and baseline HDL cholesterol entered as standard covariates, and for in-treatment Cornell product LVH, diastolic BP, BMI, HDL, hydrochlorothiazide and statin use treated as time-varying covariates, achievement of a SBP ≤130 remained associated with a 38% lower incidence (95% CI 12-57%) of new DM whereas an in-treatment SBP between 131 and 141 was no longer predictive of a reduced risk of new DM. Conclusions: Achieved SBP ≤130 is associated with a significantly lower risk of developing new-onset DM in hypertensive patients with ECG LVH, independent of other known and possible risk factors for DM. Further study will be needed to determine whether targeting hypertensive patients without DM to lower SBP goals can reduce the burden of new DM in this high-risk population.

Occurrence of and Risk Factors for Diabetes Mellitus in Chinese Patients With Chronic Pancreatitis

The aim of the study was to determine the occurrence and the risk factors of diabetes mellitus (DM) in Chinese patients with chronic pancreatitis (CP), with particular emphasis on those with endoscopic or surgical therapy for CP. Four hundred forty-five contacted CP patients in our hospital between January 1, 1997, and July 31, 2007, were followed up. Risk factors for DM were determined in a multivariate analysis after exclusion of 58 patients. The cumulative rate of DM was 51.5% (SD, 8%) at 20 years after the onset of CP and 27.8% (SD, 6%) at 10 years after endotherapy or surgery, without significant difference between the 2 therapies (P = 0.243). The age at the onset of CP (hazard ratio, 1.032; 95% confidential interval, 1.012-1.052), smoking (2.859, 1.448-5.645), chronic pain (0.412, 0.180-0.945), and pancreatic calcifications (2.326, 1.203-4.496) were identified as independent risk factors for developing DM in the patients before any invasive therapy. Smoking (2.203, 1.153-4.209) and distal pancreatectomy (5.412, 2.506-11.690) were the independent risk factors for DM development in patients after invasive therapy. The risk of DM seems to be mainly caused by progression of CP because it increased with older age, absence of chronic pain, and pancreatic calcifications, whereas this risk is influenced by smoking and distal pancreatectomy.