Diabetics show higher risk of pancreas disease

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People with type 2 diabetes may have a heightened risk of a painful condition known as acute pancreatitis, but those odds are curbed in people on diabetes drugs, a new study suggests.

Acute pancreatitis is a sudden inflammation of the pancreas that causes upper abdominal pain - often worse after eating - as well as nausea and vomiting. Mild cases may go away without treatment, but acute pancreatitis can have serious, life-threatening complications like heart, lung or kidney failure.

The disease sends about 200,000 Americans to the hospital each year.

In the new study, researchers found that among more than 97,000 Taiwanese adults followed for up to eight years, those with type 2 diabetes had twice the rate of acute pancreatitis—almost 28 cases per 10,000 people each year, versus 14 cases for every 10,000 people without diabetes.

People with diabetes were more likely to have a number of risk factors for acute pancreatitis. Those included gallstones and heavy drinking—two of the most common causes of pancreas inflammation—as well as high triglycerides (a type of blood fat) and a history of the liver infections hepatitis B or C.

But even when those conditions were taken into account, diabetes itself was linked to an 89 percent increase in the risk of acute pancreatitis.

The findings back up earlier studies that have linked type 2 diabetes to acute pancreatitis, according to senior researcher Dr. Pei-Chun Chen, of China Medical University College of Public Health in Taiwan.

But they also add something new, Chen told Reuters Health in an email.

Among people with diabetes, the study found, those on diabetes medications had a lower risk of acute pancreatitis. And the more medications they were using, the lower the risk.

The potential benefit was seen with a range of diabetes drugs—including metformin (Glucophage); sulfonylureas, which include drugs like glimepiride (Amaryl) and glipizide (Glucotrol); thiazolidinediones, including rosiglitazone (Avandia) and pioglitazone (Actos); and alpha-glucosidase inhibitors, like miglitol (Glyset) and acarbose (Precose).

In recent years, certain other diabetes drugs—including the brand names Januvia and Byetta—have been linked to cases of pancreatitis, and warnings are included in the drugs’ prescribing information.

However, it has not been clear whether the drugs themselves cause the pancreas inflammation. The medications were not specifically analyzed in the current study.

Chen said that these latest findings cannot prove that any diabetes medication protects against acute pancreatitis. Nor do they prove that diabetes, itself, causes pancreatitis in some people, the researcher said.

It’s possible, according to Chen, that something else about people with diabetes—such as high rates of obesity—account for the connection.

The researchers also lacked information on study participants’ smoking habits, and smoking is linked to an increased risk of pancreatitis.

More studies are needed, according to Chen’s team, to confirm that diabetes does contribute to pancreatitis, and that medications—or at least certain medications—are protective.

For now, Chen advised that people with diabetes be aware of the symptoms of acute pancreatitis, and call their doctor immediately if they experience them. That may be especially important, Chen noted, for diabetics with alcohol problems or hepatitis C infection.

In this study, alcoholism and hepatitis C were each stronger risk factors than diabetes for pancreatitis. And both appeared to further boost the risk linked to diabetes.

The study was funded by the Taiwanese government and China Medical University. None of the researchers reports any financial conflicts of interest.

SOURCE: American Journal of Gastroenterology, online May 17, 2011.

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