medwireNews: Postpancreatitis diabetes mellitus (PPDM) is under-recognized and often misclassified as type 2 diabetes, which can result in improper treatment, population-based study data show.
Writing in Diabetes Care, Rikke Viggers and colleagues from Aalborg University in Denmark say their findings “emphasize the current difficulties with misclassification and mistreatment of patients with PPDM and underline the urgent need for improved diagnostic methods and development of evidence-based management guidelines.”
Using the Danish National Patient Registry, Viggers and team identified 398,456 adults with new-onset diabetes between 2000 and 2018. Of these, 96.2% had type 2 diabetes, 2.3% had type 1 diabetes, and 1.5% had PPDM, which could be further classified into PPDM that developed after acute (0.9%) or chronic (0.6%) pancreatitis.
The incidence rates were 516.0, 12.5, and 7.9 cases per 100,000 person–years for type 1 diabetes, type 2 diabetes, and PPDM, respectively.
However, initial classification among people with PPDM was most commonly type 2 diabetes (44.9%) followed by type 1 diabetes (14.2%). A further 14.0% were classified as “other specified” or “unspecified” diabetes while the remaining 26.9% had no specific diabetes-related diagnosis allocated and were instead identified on the basis of glucose-lowering therapy prescription.
The researchers report that, compared with the type 2 diabetes group, the PPDM group had a significantly higher proportion of men (62.9 vs 50.1%), heavy smokers (30.4 vs 23.5%), alcohol abusers (40.2 vs 5.5%), and more people with a Charlson comorbidity score above 2 (50.5 vs 31.1%). Conversely, people with PPDM were significantly less likely to have obesity than those with type 2 diabetes (18.2 vs 21.0%).
Glucose-lowering therapies also differed among the groups. The majority (76.3%) of individuals with type 2 diabetes received a biguanide (eg, metformin) during the median 6.7 years of follow-up, but the proportion was significantly lower (64.5%) in the PPDM group, despite biguanides being “associated with a survival benefit in patients with PPDM,” Viggers et al remark.
They also note that 25.2% of people with PPDM were given sulfonylureas even though “most experts agree that glucose-lowering drugs with increased risk of hypoglycemia, such as [sulfonylureas], should generally be avoided in this condition” because of their association with highly variable glucose homeostasis.
In addition, 17.8% received incretin-based therapies despite the fact that “the prescription of incretin-based therapies has generally been advised against in patients with PPDM by most experts in the field” due to a potential increased risk for pancreatic cancer, the researchers remark.
Furthermore, after adjustment for potential confounders, individuals with PPDM were a significant 3.10 times more likely to require insulin than those with type 2 diabetes, with crude rates at 42.5% versus 17.8%. For people with PPDM after chronic pancreatitis, the risk for insulin use was a significant 4.30-fold higher than for those with type 2 diabetes.
Viggers and co-authors conclude: “Future studies should focus on more detailed clinical phenotyping and biomarkers of patients with PPDM to reveal characteristics that may be useful to identify and discern these patients from individuals with type 2 diabetes.”
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