Hyperglycemia during acute pancreatitis (HDAP) may reflect both stress responses and pancreatic islet injury, potentially distinguishing it from typical stress-induced hyperglycemia. A prospective multicenter analysis from the Diabetes Related to Acute Pancreatitis and Its Mechanisms (DREAM) study evaluated the prevalence of HDAP and its association with early-onset diabetes after recovery from acute pancreatitis (AP).
The analysis included 395 individuals without preexisting diabetes who experienced an episode of AP. Investigators assessed 2 hyperglycemia thresholds during hospitalization: peak glucose levels greater than 140 mg/dL (HDAP140) and greater than 200 mg/dL (HDAP200).
Outpatient glycemic status after recovery was evaluated a median of 111 days after AP using fasting glucose, oral glucose tolerance testing, and glycated hemoglobin (HbA1c).
Findings
- HDAP140 occurred in 37.5% of participants, while HDAP200 occurred in 7.1%.
- Age, race, AP etiology, and AP severity were significant predictors of HDAP140.
- Early-onset diabetes after recovery developed in 14.8% of participants with HDAP140 compared with 1.2% of those without HDAP140 (P = 0.0001).
- Among participants with HDAP200, 42.9% developed early-onset diabetes compared with 3.5% of those without HDAP200 (P = 0.0001).
- Absence of HDAP140 and HDAP200 was associated with negative predictive values of 99% and 97%, respectively, for subsequent diabetes.
HDAP was associated with increased risk of early-onset diabetes after recovery from AP, particularly among individuals with HDAP200. Monitoring glycemia during AP may help identify patients who could benefit from closer postdischarge diabetes surveillance.
