Affiliation:
1. Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
2. Data Science Team, Hanmi Pharmaceutical Co., Ltd, Seoul, South Korea
3. Veterans Affairs Puget Sound Health Care System, Seattle, WA
Abstract
OBJECTIVE
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.
RESEARCH DESIGN AND METHODS
Using the Korean National Health Insurance Service–Health Screening Cohort between 2012 and 2017, we divided patients with diabetes 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.
RESULTS
DEP was associated with a higher risk of insulin use than type 2 diabetes (adjusted hazard ratio 1.38 at 5 years [95% CI 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.
CONCLUSIONS
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 with type 2 diabetes.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
3 articles.
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