Hypertriglyceridemia, an important and independent risk factor for acute pancreatitis in patients with type 2 diabetes mellitus

Abstract

Purpose: Acute pancreatitis (AP) is a frequent inflammatory disease of the pancreas with multiple causes, among which high triglyceride (TG) level is the most common. The main purpose of this study has been to research the prevalence of AP in patients with diabetes mellitus (DM) and to underline the importance of hypertriglyceridemia (HTG) as a risk factor in triggering AP. The possible link between AP and glycemic control has been studied also, alongside some cardiovascular risk factors and long-term diabetes complications.

Patients and methods: The patient cohort comprised 1,586 patients with DM, admitted to the Internal Medicine Clinic of Diabetes, Nutrition and Metabolic Disease within the Emergency Hospital in Timisoara between January and August 2016. Following a series of clinical and biological investigations, these patients were diagnosed with AP. The patients' antidiabetic treatment and chronic diabetes-related complications have also been recorded.

Results: The prevalence of pancreatitis in this group of patients was 3.7%. The presence of pancreatitis was associated with a higher HbA1c (8.5% vs 7.7%; P<0.001), fasting glycemia (167.5 vs 95 mg/dL; P<0.001), postprandial glycemia (244.5 vs 118 mg/dL; P<0.001), total cholesterol (256.5 vs 189.5 mg/dL; P<0.001), low-density lipoprotein cholesterol (LDLc) (208.7 vs 112.8 mg/dL; P<0.001), and TGs (495 vs 161 mg/dL; P<0.001). HDL cholesterol (HDLc) was found to be a significant protective factor against the risk of pancreatitis. On the contrary, high LDLc values were a significant risk factor for pancreatitis along with high non-HDLc and high TG values, respectively.

Conclusion: The development of AP events in patients with DM is associated with unsatisfactory glycemic control, HTG, hypertension, and the presence and severity of DM chronic complications. In this study, the prevalence of AP events in patients with DM was 3.7%.

Keywords: acute pancreatitis; diabetes mellitus; hypertriglyceridemia; insulin resistance.

Figure 1

Diagram of the study flow. Abbreviations: DM, diabetes mellitus; AP, acute pancreatitis.

Figure 2

Multivariate risk analysis for pancreatitis in DM patients. The risk is expressed per 1 percentage point increase for HbA1c, and 1 mg/dL point increase for fasting glycemia, postprandial glycemia, total cholesterol, HDLc, LDLc, and TGs. For polyneuropathy, peripheral arteriopathy, and retinopathy, the risk is expressed as dichotomous variables, while for CV comorbidities, the risk is expressed per one associated CV comorbidity. Abbreviations: HDLc, high-density lipoprotein cholesterol; LDLc, low-density lipoprotein cholesterol; CV, cardiovascular.