Glycaemic control and influencing factors among patients with post-chronic pancreatitis diabetes mellitus in China: a retrospective cross-sectional study.

Abstract

Post-chronic pancreatitis (CP) diabetes mellitus (PPDM-C) is a distinct form of diabetes, in which complex pathogenesis hampers adequate glycaemic control. This study aimed to identify risk factors for poor glycaemic status in PPDM-C to guide clinical management. Cross-sectional study. Shanghai, China. Between January 2018 and March 2023, 1677 patients with CP were enrolled in the CP database of the National Clinical Research Center. After application of strict exclusion criteria, 302 patients diagnosed with PPDM-C were included in the study. The primary outcome was glycaemic control. The secondary outcomes were factors that affect glycaemic control among patients with PPDM-C. This retrospective study was conducted in patients with PPDM-C. Poor glycaemic status was defined as a glycated haemoglobin A1c level of >7% at admission. Patients were stratified into those with and without diabetes treatment. Multivariate logistic regression was performed to identify risk factors. The area under the curve (AUC) analysis was used to evaluate the predictive efficacy of these risk factors. A total of 302 patients with PPDM-C were analysed. Poor glycaemic status was observed in 72.6% (61/84) of patients without diabetes treatment and 52.8% (115/218) of those with diabetes treatment. For those without diabetes treatment, a history of acute pancreatitis (AP) attacks (OR: 4.838, p<i>=</i>0.014) and smoking (1-20 pack-years, OR: 4.418; >20 pack-years, OR: 9.989; p<0.031) were identified as risk factors, with an AUC of 0.840 (p<i><</i>0.001). In patients with diabetes treatment, AP attack history (OR: 5.640, p<0.001) and smoking (1-20 pack-years, OR: 4.471; >20 pack-years, OR: 11.395; p<0.001) in a dose-dependent manner were found to be independent risk factors, with an AUC of 0.785 (p<0.001). Patients with PPDM-C in China exhibited a high prevalence of poor glycaemic status. Smoking and a history of AP attacks were significantly associated with an increased risk of poor glycaemic control. The early identification of patients with PPDM-C at elevated risk of poor glycaemic control may facilitate timely and optimised management of glycaemia.