title: Patients with type 2 diabetes mellitus have higher risk for acute pancreatitis compared with those without diabetes.
abstract: OBJECTIVE
  The aetiology of acute pancreatitis (AP) is complex, and many risk factors for AP are shared by patients with type 2 diabetes mellitus (T2DM). However, few have assessed risk factors for AP specifically in T2DM patients.
  
  
  METHODS
  Patients in the General Practice Research Database (2 984 755, 5.0% with T2DM) were used to estimate incidence of AP for T2DM relative to non-diabetes, adjusting for prior pancreatitis, gallbladder disease, obesity, smoking and alcohol use. Multivariate Cox regression analysis adjusting for risk factors and Charlson comorbidity index (CCI) was used to estimate hazard ratios (HR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Between 2003 and 2007, 301 of 148 903 patients with T2DM and 2434 of almost 3 million patients without diabetes developed AP. Patients with T2DM had higher risk for AP compared with patients without diabetes (crude HR: 2.89, 95% CI: 2.56-3.27). Patients with T2DM had significantly higher rates of prior alcohol and tobacco exposure (44.2 and 61.9% vs. 34.1 and 35.9%, p < 0.001) and of comorbid conditions (14.7% with CCI > or =1 vs. 4.3%, p < 0.001). Histories of obesity, pancreatitis, gallbladder disease, smoking or alcohol use were significant predictors of AP. After adjusting for these factors, age, gender and comorbidities, the risk of developing AP remained elevated in patients with T2DM (adjusted HR: 1.49, 95% CI: 1.31-1.70).
  
  
  CONCLUSIONS
  After adjusting for risk factors, patients with T2DM had an elevated risk of AP compared with patients without diabetes. Physicians should be aware of the increased risk in patients with T2DM, particularly in those with prior pancreatitis.
authors.affiliation: Global Clinical Development and Regulatory Affairs, Merck Research Laboratories, North Wales, PA 19454, USA. cindy_girman@merck.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Girman
authors.forename: T D
authors.initials: TD
authors.lastname: Kou
authors.forename: B
authors.initials: B
authors.lastname: Cai
authors.forename: C M
authors.initials: CM
authors.lastname: Alexander
authors.forename: E A
authors.initials: EA
authors.lastname: O'Neill
authors.forename: D E
authors.initials: DE
authors.lastname: Williams-Herman
authors.forename: L
authors.initials: L
authors.lastname: Katz
mesh_terms: D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D017678:Sex Distribution