PhD Scientific Days 2024

Budapest, 9-10 July 2024

Pathological and Oncological Sciences I.

Time course development of diabetes mellitus following acute pancreatitis: Interim analysis of the GOULASH PLUS trial

Author(s)

Mónika Lipp1, Andrea Szentesi2, Zsolt Abonyi-Tóth3, Vivien Vass4, Katalin Márta5, Ferenc Izbéki6, László Gajdán6, Bálint Erőss5, Péter Hegyi* (*contributed equally)7, Alexandra Mikó* (*contributed equally)8, Hungarian Pancreatic Study Group9
1: Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
2: Centre for Translational Medicine, Semmelweis University, Budapest, Hungary ; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
3: Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
4: Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary,
5: Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary,
6: Szent György Teaching Hospital of Fejér County, Székesfehérvár, Hungary,
7: Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary
8: Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary
9: Hungarian Pancreatic Study Group

Text of the abstract

Introduction
96-98% of patients survive acute pancreatitis (AP), but in the post-AP phase, patients are at high risk of morbidity and mortality. One of the objectives of the GOULASH PLUS (ISRCTN63396106) longitudinal, observational multicentre study is to investigate the development of diabetes mellitus (DM) following AP. The GOULASH PLUS trial reached 50% of the planned patient enrolment.
Aims
This interim data analysis aims to understand the time course evolution of DM after AP.
Methods
Data from 349 patients were collected on DM using HbA1c and oral glucose tolerance tests (OGTT). We formed four groups according to the baseline morphology status of the exocrine pancreas: 1) AP with one episode, 2) Recurrent acute pancreatitis (RAP) with two episodes, 3) Early chronic pancreatitis (ECP) with characteristic signs on imaging or three or more episodes of AP and 4) Chronic pancreatitis (CP). Abdominal ultrasonography in the first and third years and endoscopic ultrasound or magnetic-resonance-cholangiopancreatography in the second and fourth years were conducted.
Results:
Out of the 359 patients monitored following AP, 268 (74.6%) were grouped into AP, 43 (12.0%) into RAP, 25 (7.0%) into ECP, and 23 (6.4%) in the CP groups. Before the initial AP episode, in the AP group, 14.6% of patients had DM, whereas, 27.6% had prediabetes (preDM). In the RAP group 12.5% had DM and 18% preDM, in the ECP group 3.8% had DM and 38.5% preDM, whereas in the CP group, 17.2% had DM and 35.4% preDM. The following data represent the results at 1, 2, 3, and 4 years after AP. In the AP group, 24.3%, 30.1%, 32.3%, and 36.7% presented with DM, and 35.4%, 39.1%, 38.2%, and 36.6% with preDM. In the RAP group 31.3%, 49.8%, 41.1%, 42.9% presented with DM, and 39.1%, 36.4%, 40.9%, and 42.9% with preDM. In the ECP cohort, 29.6%, 37.5%, 43.3%, and 30.6% presented with DM, while 35.1%, 30.8%, 28.7%, and 37.9% with preDM. Among patients with CP, 39.1%, 60.7%, 54.0%, and 62.3% presented with DM, and 43.9%, 31.0%, 46.0%, and 23.0% with preDM.
Conclusion:
AP patients with advanced morphological changes in the pancreas face a heightened risk of developing DM or preDM within the first four years after their episode.
Funding:
SE250+ fellowship 2024