OBJECTIVE This study was conducted to describe the incidence of diabetes following pancreatic disease, assess how these patients are classified by clinicians, and compare clinical characteristics with type 1 and type 2 diabetes.

RESEARCH DESIGN AND METHODS Primary care records in England (n = 2,360,631) were searched for incident cases of adult-onset diabetes between 1 January 2005 and 31 March 2016. We examined demographics, diabetes classification, glycemic control, and insulin use in those with and without pancreatic disease (subcategorized into acute pancreatitis or chronic pancreatic disease) before diabetes diagnosis. Regression analysis was used to control for baseline potential risk factors for poor glycemic control (HbA_1c ≥7% [53 mmol/mol]) and insulin requirement.

RESULTS We identified 31,789 new diagnoses of adult-onset diabetes. Diabetes following pancreatic disease (2.59 [95% CI 2.38–2.81] per 100,000 person-years) was more common than type 1 diabetes (1.64 [1.47–1.82]; P < 0.001). The 559 cases of diabetes following pancreatic disease were mostly classified by clinicians as type 2 diabetes (87.8%) and uncommonly as diabetes of the exocrine pancreas (2.7%). Diabetes following pancreatic disease was diagnosed at a median age of 59 years and BMI of 29.2 kg/m². Diabetes following pancreatic disease was associated with poor glycemic control (adjusted odds ratio, 1.7 [1.3–2.2]; P < 0.001) compared with type 2 diabetes. Insulin use within 5 years was 4.1% (3.8–4.4) with type 2 diabetes, 20.9% (14.6–28.9) with diabetes following acute pancreatitis, and 45.8% (34.2–57.9) with diabetes following chronic pancreatic disease.

CONCLUSIONS Diabetes of the exocrine pancreas is frequently labeled type 2 diabetes but has worse glycemic control and a markedly greater requirement for insulin.

目的本研究旨在描述胰腺疾病后糖尿病的发生率，评估临床医生如何对这些患者进行分类，并将临床特征与1型和2型糖尿病进行比较。

研究设计和方法检索2005年1月1日至2016年3月31日期间在英格兰（n = 2,360,631）的成年糖尿病发病病例的初级保健记录。我们对患有以下疾病的患者的人口统计学，糖尿病分类，血糖控制和胰岛素使用情况进行了研究。在糖尿病诊断之前没有胰腺疾病（分为急性胰腺炎或慢性胰腺疾病）。回归分析被用来控制用于血糖控制不佳（HBA基线潜在危险因素_1C ≥7％[53毫摩尔/摩尔]）和胰岛素需求。

结果我们确定了31,789例新诊断为成人发病的糖尿病。胰腺疾病后的糖尿病（每100,000人年2.59 [95％CI 2.38–2.81]）比1型糖尿病更常见（1.64 [1.47–1.82]；P <0.001）。胰腺疾病后的559例糖尿病大多数被临床医生分类为2型糖尿病（87.8％），很少被分类为外分泌胰腺糖尿病（2.7％）。胰腺疾病后糖尿病的诊断年龄中位数为59岁，BMI为29.2 kg / m ²。胰腺疾病后糖尿病与血糖控制不佳相关（校正比值比为1.7 [1.3-2.2]；P<0.001）与2型糖尿病相比。2型糖尿病患者5年内的胰岛素使用率为4.1％（3.8–4.4），急性胰腺炎后糖尿病患者的胰岛素使用率为20.9％（14.6–28.9），慢性胰腺疾病后糖尿病患者的胰岛素使用率为45.8％（34.2–57.9）。

结论外分泌胰腺糖尿病常被标记为2型糖尿病，但血糖控制较差，对胰岛素的需求明显增加。