Association between diabetic status and risk of acute pancreatitis: A nationwide population-based study.

Objective: There have been several epidemiologic studies on the association between diabetes mellitus and acute pancreatitis. However, there is no solid evidence, and the effect of diabetes mellitus severity on acute pancreatitis incidence is not well known. This study aimed to evaluate the association between diabetic status and the risk of acute pancreatitis in a nationwide population-based cohort.

Methods: Among the participants who underwent national health examinations between 2009 and 2012, patients with diabetes mellitus were included. Patients diagnosed with acute pancreatitis before the health examination or diagnosed with pancreatitis within 1 year following the examination were excluded. The association between the number of oral hypoglycemic agents (<3 or ≥3) or insulin use during examination and acute pancreatitis occurrence was analyzed after follow-up until December 31, 2018.

Results: Overall, 2,444,254 patients were included in the final analysis. During the follow-up period, acute pancreatitis occurred in 10,360 patients with an incidence ratio of 0.585 per 1,000 person-years, and it was observed that the risk of acute pancreatitis sequentially increased between patients taking oral hypoglycemic agents <3 (incidence ratio = 0.546), those taking ≥3 (incidence ratio = 0.665), and those using insulin (incidence ratio = 0.872). The adjusted hazard ratios of patients taking three or more hypoglycemic agents and those using insulin were 1.196 (95% confidence interval (CI) 1.123-1.273) and 1.493 (95% CI 1.398-1.594), respectively.

Conclusions: As diabetes mellitus severity increases, the risk of acute pancreatitis increases.