Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7367-7374
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7367
Impaired glucose tolerance in acute pancreatitis
Kazuhiro Kikuta, Atsushi Masamune, Tooru Shimosegawa
Kazuhiro Kikuta, Atsushi Masamune, Tooru Shimosegawa, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Author contributions: Kikuta K and Masamune A contributed equally to this work; Kikuta K, Masamune A and Shimosegawa T designed the study; Kikuta K, Masamune A and Shimosegawa T conducted the research; Kikuta K and Masamune A analyzed the data; and Kikuta K, Masamune A and Shimosegawa T wrote the paper.
Supported by Grants from the Smoking Research Foundation (to Masamune A); the Research Committee on Intractable Pancreatic Diseases, the Ministry of Health, Labour and Welfare of Japan (Principal investigators: Shimosegawa T and Takeyama Yoshifumi).
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Atsushi Masamune, MD, PhD, Associate Professor, Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. amasamune@med.tohoku.ac.jp
Telephone: +81-22-7177172 Fax: +81-22-7177177
Received: December 26, 2014
Peer-review started: December 27, 2014
First decision: February 10, 2015
Revised: February 23, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: June 28, 2015
Processing time: 184 Days and 22.9 Hours
Abstract

Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In spite of the pivotal role of the endocrine pancreas in glucose metabolism, the impact of impaired glucose tolerance on AP has not been fully elucidated. A meta-analysis of seven observational studies showed that type 2 diabetes mellitus (DM) was associated with an increased risk of AP. The increased risk of AP shown in the meta-analysis was independent of hyperlipidemia, alcohol use and gallstones. Anti-diabetic drugs including incretins might increase the risk of AP, but no intervention trials have confirmed this. Although a controversial finding, DM seems to be associated with severe attacks and organ failure in AP. We analyzed the results of a nationwide epidemiological survey of AP in Japan. We studied the impact of pre-existing DM on the clinical course of AP in 1954 cases for which information on DM status was available at the onset of AP. The prevalence of DM in AP patients (12.8%) was higher than that in the general population in Japan (10.5%). AP patients with DM had higher morbidity of cardiovascular and renal failure than those without DM. About 35% of the idiopathic AP patients with DM had renal failure. The mortality of AP patients with DM (4.0%) was higher than that of AP patients without DM (1.7%). If stratified by etiology, idiopathic, but not alcoholic or biliary, AP patients with DM were predisposed to increased mortality (9.7%). In conclusion, impaired glucose tolerance might have an impact on the development and clinical outcome of AP. However, the impact might depend on the cause of hyperglycemia, the condition of DM including severity, duration and treatment, and the characteristics of the AP patients including age, etiology and comorbidity.

Keywords: Alcohol; Diabetes mellitus; Epidemiology; Gallstone; Mortality; Organ failure

Core tip: We analyzed the results of a nationwide epidemiological survey of acute pancreatitis (AP) in Japan to clarify the impact of pre-existing diabetes mellitus (DM) on the clinical course of AP. AP patients with DM had higher mortality and morbidity of cardiovascular and renal failure than those without DM. About 35% of the idiopathic AP patients with DM had renal failure. If stratified by etiology, idiopathic, but not alcoholic or biliary, AP patients with DM had higher mortality than those without DM. Impaired glucose tolerance might have an impact on the development and clinical outcome of AP.