MON-585 Exocrine Pancreatic Insufficiency Is a Risk Factor for Future Development of Diabetes Mellitus

Abstract Disclosure: J. Gore: None. K.G. Romo: None. A.A. Noor: None. A. Zia: None. S. Sharma: None. G.I. Uwaifo: None. Introduction: Exocrine Pancreatic insufficiency (EPI) is an underdiagnosed disease of multivariate etiology resulting in extensive damage to the exocrine pancreas function which requires enzyme replacement therapy. While many patients with EPI also have diabetes (DM), the risk for future diabetes onset among those without is not well defined. Methods: A retrospective records review of the Electronic Health records from a large regional health care system from Jan 2017 to Jan 2020 was obtained to identify patients with EPI with and without DM at the start of the observation period. Evaluation of the incident rate of new DM diagnoses during the period of observation was obtained. A comparator cohort of patients with obesity with and without DM from the same health system was also evaluated for new DM diagnoses over the same time period. Results: Of a total patient population of 1.327 million, 1,798 patients with EPI were identified with 431 having DM at the start of observation (∼ 24% prevalence). By the end of the observation period there were 813 patients with DM (∼ 45.2% final prevalence) and a consequent incident rate of 21.2 % in 3 years. Of the EPI patients, 45.2% had DM, 33.8% had pancreatitis and 12.8% had cystic fibrosis. Pancreatic cancer (27.7%) and pancreatic surgery (2.9%) were the other most common etiologic associations. 849, 380 patients were obese at the start of the observation period with DM prevalence of 15.8%. The mean BMI for the Obese cohort was 33.58 kg/ m2. Despite having a mean BMI of 26.56kg/m2, EPI patients without DM had a greater diabetes incidence rate than obese patients without DM but no EPI from the same practice population over the same observation period (21.2% vs 11.4%). Conclusion: While EPI is associated with a high prevalence of DM, it is also important to be aware that it is associated with a similarly high-risk potential for incident DM development exceeding that associated with obesity. Consequently, non-diabetic EPI patients need ongoing clinical surveillance of glycemic profile prospectively to enable early detection of DM onset with its attendant cardiometabolic complications. Presentation: Monday, July 14, 2025