S214 Increased Odds of Developing Diabetes Following Sentinel Episode of Acute Pancreatitis in Patients With Obesity: A Propensity-Matched Population Study

Introduction: Acute pancreatitis (AP) is among the most common causes of diabetes mellitus (DM) secondary to diseases of the exocrine pancreas. Obesity is a shared risk factor for both AP and DM; however, the longitudinal risk of developing DM after AP in patients with obesity is not well understood. In this study, we assess the risk of developing DM following a sentinel episode of AP in patients with obesity. Methods: A retrospective cohort study was conducted using TriNetX, a multi-institutional research network. The study population was limited to patients with obesity based on International Classification of Diseases (ICD) codes or BMI ≥30 kg/m2. Cases with AP (based on ICD code K85) and controls without a history of AP were selected. Patients with DM, prediabetes (based on ICD codes or HbA1c ≥5.7%), or use of diabetes medications prior to index AP episode or the diagnosis of obesity for controls were excluded. Patients with glucagon-like peptide-1 medications, alcohol-related pancreatitis, alcohol-related disorders, pancreatic cancer, pancreatic surgery, and cystic fibrosis were also excluded. Patients were required to have at least 1 outpatient visit following the index episode of AP (cases) or diagnosis of obesity (controls). Propensity score matching was performed on the basis of age, sex, race, ethnicity, and BMI. New diagnosis of diabetes between groups was compared at multiple timepoints (within 1, 3, 6, 12, 36, and 60 months) following the index event. Results: A total of 11,466 patients were identified in the AP group and 6,378,842 patients were identified in the control group. Propensity matching was successful with 11,464 cases and 11,464 controls (SMD <0.1), Baseline characteristics were similar in regard to age, sex, race, ethnicity, BMI. Odds ratios for new diagnosis of DM in the AP group compared to propensity matched controls were 3.13, 2.66, 2.52, 2.12, 1.96, and 1.77 within 1, 3, 6, 12, 36, and 60 months, respectively. Conclusion: In this large retrospective cohort study, odds of developing DM in the AP group when compared to a matched control cohort with obesity were highest at timepoints immediately following the index event. Furthermore, odds of developing DM exceeded what was observed in matched controls at each timepoint, suggesting there may be additional mechanisms underlying DM following AP beyond shared risk factors. Further investigations are needed to identify opportunities for risk factor reduction and prevention strategies.