Development of a Clinical Prediction Model for Diabetes in Chronic Pancreatitis: The PREDICT3c Study

Objective: Diabetes arising in chronic pancreatitis (CP) is associated with increased morbidity and mortality. Thus, methods to predict which CP patients are at greatest risk for diabetes are urgently needed. We aimed to examine independent risk factors for diabetes in a large cohort of CP. 

Research Design and Methods: This cross-sectional study consisted of 645 individuals enrolled in the PROCEED study with CP, of whom 276 had diabetes. We conducted univariable and multivariable regression analyses of potential risk factors for diabetes. Model performance was assessed with area under the receiver operating curve (AUROC) analysis, and accuracy was evaluated by cross-validation. Exploratory analyses stratified the diabetes cases according to the timing of development of diabetes relative to the diagnosis of pancreatitis. 

Results: Independent correlates of diabetes in CP included risk factors for type 2 diabetes (older age, overweight/obese status, male, non-White race, tobacco use) as well as pancreatic disease-related factors (history of acute pancreatitis complications, non-alcoholic etiology of CP, exocrine pancreatic dysfunction, pancreatic calcification, pancreatic atrophy) (AUROC 0.745). Type 2 diabetes risk factors predominated in diabetes occurring before pancreatitis, and pancreatic disease-related factors predominated in diabetes occurring after pancreatitis. 

Conclusion: Multiple factors are associated with diabetes in CP, including canonical risk factors for type 2 diabetes and features associated with pancreatitis severity. This study lays the groundwork for the future development of models integrating clinical and non-clinical data to identify CP patients at risk for diabetes and identifies modifiable risk factors (obesity, smoking) on which to focus for diabetes prevention.