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DC21-0333_Online-Only_Supplemental_Material_PPDM_R1.pdf (253.04 kB)

Glucose-Lowering Therapy in Patients With Postpancreatitis Diabetes Mellitus: A Nationwide Population-Based Cohort Study

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posted on 2021-08-06, 16:26 authored by Rikke Viggers, Morten Hasselstrøm Jensen, Henrik Vitus Bering Laursen, Asbjørn Mohr Drewes, Peter Vestergaard, Søren Schou Olesen

Objective: Postpancreatitis diabetes mellitus (PPDM) is a type of secondary diabetes that requires special considerations for management. The main objective was to examine prescription patterns of glucose-lowering therapy among adults with PPDM compared to type 1 and type 2 diabetes.

Research Design and Methods: In a Danish nation-wide population-based cohort study we identified all individuals with adult-onset diabetes mellitus in the period 2000-2018 and categorized them as type 1 diabetes, type 2 diabetes or PPDM. We ascertained diabetes incidence rates, clinical and demographic characteristics, classifications and prescription patterns of glucose-lowering therapy and compared these parameters across diabetes subgroups.

Results: Among 398,456 adults with new-onset diabetes mellitus, 5,879 (1.5%) had PPDM, 9,252 (2.3%) type 1 diabetes and the remaining type 2 diabetes (96.2%). The incidence rate of PPDM was 7.9 (95% CI 7.7-8.1) per 100,000 person-years vs. 12.5 (95% CI 12.2-12.7) for type 1 diabetes (incidence-rate-ratio 0.6; 95% CI 0.6-0.7, p<0.001). A sizeable proportion of PPDM patients were classified as type 2 diabetes (44.9%) and were prescribed sulfonylureas (25.2%) and incretin-based therapies (18.0%) that can potentially be harmful in PPDM. In contrast, 35.0% of patients never received biguanides, which are associated with a survival benefit in PPDM. Increased insulin requirements were observed for patients with PPDM compared to type 2 diabetes (hazard ratio 3.10; 95% CI 2.96-3.23, p<0.001) in particular for PPDM associated with chronic pancreatitis (hazard ratio 4.30; 95% CI 4.01-4.56, p<0.001).

Conclusions: PPDM is a common type of secondary diabetes in adults but is often misclassified and treated as type 2 diabetes, although PPDM requires special considerations for management.

Funding

This work was supported by Steno Collaborative grant, Novo Nordisk Foundation, Denmark (Grant no. NNF18OC0052064).

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