S132 Evaluating the Severity of Acute Pancreatitis in Type 2 Diabetes Patients Treated With Incretin-Based Therapies vs Insulin: A Multicenter Retrospective Analysis Using APACHE II

Introduction: Incretin-based therapies, such as GLP-1 receptor agonists and DPP-IV inhibitors, are commonly prescribed for type 2 diabetes mellitus (T2DM), but concerns about their potential link to acute pancreatitis (AP) persist. While several large-scale studies have assessed AP risk, few have examined its severity. Validated scoring systems such as APACHE II are rarely used to assess illness severity in this context, in published studies of AP associated with incretin therapy. We evaluated AP severity in hospitalized T2DM patients treated with GLP-1/DPP-IV inhibitors vs insulin using real-world multicenter data. Methods: We conducted a multicenter retrospective review of adult T2DM patients hospitalized with AP across HCA Healthcare facilities (2005 to 2024). AP was identified using ICD coding and confirmatory clinical documentation (e.g., imaging, enzyme levels), when available. Patients were grouped by home diabetes treatment: GLP-1/DPP-IV inhibitors or insulin. The primary outcome was AP severity (admission APACHE II scores); secondary outcomes included in-hospital mortality and discharge disposition. Multivariable linear and logistic regression models adjusted for Elixhauser Comorbidity Index (ECI) and BMI. Results: Out of 622 patients screened, 569 met inclusion criteria (GLP-1/DPP-IV: n = 73; insulin: n = 496). GLP-1/DPP-IV patients were older (65.5 vs 55.7 years) and had lower BMI (30.4 vs 33.6). APACHE II scores were higher in this group (12.4 vs 11.3), though the difference approached but did not reach statistical significance (β = 0.80; 95% CI: –0.06 to 1.66; P = 0.07). In-hospital mortality was low and comparable (1.37% vs 1.81%; odds ratio = 0.57; 95% CI: 0.07–4.68; P = 0.60), though the low event rate may limit interpretation. Higher ECI scores were independently associated with increased severity and mortality (P < 0.05). The small sample size in the GLP-1/DPP-IV group may have limited detection of subtle differences. Conclusion: In this real-world cohort, GLP-1/DPP-IV therapy was not associated with significantly worse AP severity or in-hospital mortality compared to insulin. While a non-significant trend toward higher severity was observed in the GLP-1/DPP-IV group, further investigation into larger studies is warranted. Incretin-based therapies were not associated with significantly worse pancreatitis severity or mortality compared to insulin, supporting their continued use in T2DM patients while highlighting the impact of comorbidities on outcomes.