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Characteristics and Clinical Course of Diabetes of the Exocrine Pancreas: A Nationwide Population-Based Cohort Study

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posted on 28.02.2022, 20:21 by Nami Lee, So Jeong Park, Dongwoo Kang, Ja Young Jeon, Hae Jin Kim, Dae Jung Kim, Kwan-Woo Lee, Edward J. Boyko, Seung Jin Han

The natural course of diabetes of the exocrine pancreas (DEP) is not well established. We aimed to compare the risk of insulin initiation, diabetic complications, and mortality between DEP and type 2 diabetes.


Using the Korean National Health Insurance Service–Health Screening Cohort between 2012-2017, we divided diabetic patients into those with diabetes without prior pancreatic disease (indicated type 2 diabetes, n=153,894) and diabetes with a prior diagnosis of pancreatic disease (indicated DEP, n=3,629). ICD-10 codes and pharmacy prescription information were used to define type 2 diabetes, DEP, and acute and chronic diabetes complications. Kaplan-Meier curves were produced to compare insulin use over time between groups. We created logistic regression models for odds of progression to diabetic complications and mortality.


DEP was associated with a higher risk of insulin use than type 2 diabetes (adjusted hazard ratio 1.38 at 5 years [95% confidence interval 1.30–1.47], p<0.0001). Individuals with DEP showed higher risks of hypoglycemia (odds ratio 1.85 [1.54–2.21], p<0.0001), diabetic neuropathy (1.38 [1.28–1.49], p<0.0001), nephropathy (1.38 [1.27–1.50], p<0.0001), retinopathy (1.10 [1.01–1.20], p=0.0347), coronary heart disease (1.59 [1.48–1.70], p<0.0001), cerebrovascular disease (1.38 [1.28–1.49], p<0.0001), and peripheral arterial disease (1.34 [1.25–1.44], p<0.0001). All-cause mortality was higher in those with DEP (1.74 [1.57–1.93], p<0.0001) than in those with type 2 diabetes.


DEP is more likely to require insulin therapy than type 2 diabetes. Hypoglycemia, micro- and macrovascular complications, and all-cause mortality events are higher in DEP compared to type 2 diabetes.


This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) [No. NRF-2018R1C1B5044056] and Korea Medical Institute (KMI, Seoul, South Korea) Grant Program. This study used data from the National Health Information Database (NHIS-2019-1-551).