Increased Risk of Acute Pancreatitis and Biliary Disease Observed in Patients With Type 2 Diabetes: A retrospective cohort study

Original Research

Increased Risk of Acute Pancreatitis and Biliary Disease Observed in Patients With Type 2 Diabetes

Diabetes Care 2009 May; 32(5): 834-838. https://doi.org/10.2337/dc08-1755

Table 1

Patient selection criteria for a retrospective claims database study of the risk of pancreatitis or biliary disease associated with type 2 diabetes

	Patients remaining	Patients removed
Enrolled in health plan at any time from 1 January 1999 through 31 December 2005	29,332,477	—
Total population aged ≥18 years as of 1 January 2000, continuous enrollment for ≥1 year from 1 January 1999 through 31 December 2005	12,210,809	17,121,668
At least 30 days of continuous enrollment from the end of 1-year enrollment	9,249,211	2,961,598
Control cohort: patients without diabetes
No medical claims for diabetes (250.xx) during the study period	8,579,024	670,187
No claims for antidiabetes medication during study period	8,521,490	57,534
Sex is unknown	8,519,558	1,932
Any medical claims during the study period	6,947,299	1,572,259
Study cohort: type 2 diabetes
Claim for type 2 diabetes or antidiabetic medication at any time from 1 January 1999 through 31 December 2005	1,337,081	—
Claim for type 2 diabetes or antidiabetes medication during the continuous enrollment period	640,504	696,577
Medical claim for type 2 diabetes (250.x0 or 250.x2) during the continuous enrollment period	563,827	76,677
Claim for antidiabetes medication during the continuous enrollment period	463,046	100,781
Medical claim for type 2 diabetes (250.x0 or 250.x2) AND a claim for an antidiabetes medication during 1 January 1999 through 31 December 2005	386,369	76,677
Drop patients on insulin-only therapy AND claim for type 1 diabetes (250.x1 or 250.x3)	352,633	33,736
Sex is known	352,569	64
Matching
Pairs matched 1:1 by sex and age category	352,569	—
Pairs with available claims data	337,067	15,502

Table 2

Incidence of acute pancreatitis associated with type 2 diabetes stratified by age and sex from a retrospective claims database study, 2000–2005

	Nondiabetic cohort				Type 2 diabetic cohort				IRR: type 2 diabetic cohort vs. nondiabetic cohort (95% CI)
	n^*	Incident cases	Person-years of follow-up	Incidence rate per 100,000 person-years (95% CI)	n	Incident cases	Person-years of follow-up	Incidence rate per 100,000 person-years (95% CI)	IRR: type 2 diabetic cohort vs. nondiabetic cohort (95% CI)
Overall age	336,410	827	553,959.28	149.29 (139.11–159.46)	334,930	2,551	604,684.35	421.87 (405.50–438.24)	2.83 (2.61–3.06)
18–30 years	13,628	9	17,029.62	52.85 (18.32–87.38)	13,553	81	19,780.12	409.50 (320.32–498.68)	7.75 (3.89–15.43)
31–44 years	78,518	105	120,783.10	86.93 (70.30–103.56)	78,051	584	132,996.11	439.11 (403.50–474.72)	5.05 (4.10–6.22)
45–54 years	120,354	272	200,359.38	135.76 (119.62–151.89)	119,823	862	217,352.86	396.59 (370.11–423.07)	2.92 (2.55–3.35)
55–64 years	91,859	273	154,084.70	177.18 (156.16–198.19)	91,526	723	167,069.73	432.75 (401.21–464.30)	2.44 (2.13–2.81)
≥65 years	32,051	168	61,702.48	272.27 (231.10–313.45)	31,977	301	67,485.52	446.02 (395.63–496.41)	1.64 (1.36–1.98)
Sex
Female	148,868	370	242,728.54	152.43 (136.90–167.97)	148,288	1058	267,658.93	395.28 (371.46–419.10)	2.59 (2.30–2.92)
Male	187,542	457	311,230.74	146.84 (133.37–160.30)	186,642	1493	337,025.42	442.99 (420.52–465.46)	3.02 (2.72–3.35)

↵*Patients with events of acute pancreatitis (n = 594 from the nondiabetic cohort and n = 1,883 from the type 2 diabetic cohort) or chronic pancreatitis (n = 162 from the nondiabetic cohort and n = 656 from the type 2 diabetic cohort) during the 1-year baseline period were excluded from the numerator and the denominator. In addition, patients with chronic pancreatitis during follow-up were excluded (n = 26 from the nondiabetic cohort and n = 161 from the type 2 diabetic cohort). Note that some patients may have had more than one exclusionary event.

Table 3

Incidence of biliary disease associated with type 2 diabetes stratified by age and sex from a retrospective claims database study, 2000–2005

	Nondiabetic cohort				Type 2 diabetic cohort				IRR: type 2 diabetic cohort vs. nondiabetic cohort (95% CI)
	n^*	Incident cases	Person-years of follow-up	Incidence rate per 100,000 person-years (95% CI)	n	Incident cases	Person-years of follow-up	Incidence rate per 100,000 person-years (95% CI)	IRR: type 2 diabetic cohort vs. nondiabetic cohort (95% CI)
Overall age	333,529	4,019	545,088.58	737.31 (714.52–760.11)	330,742	8,322	589,693.44	1,411.24 (1,380.92–1,441.56)	1.91 (1.84–1.99)
18–30 years	13,557	72	16,884.62	426.42 (327.92–524.92)	13,354	309	19,217.66	1,607.90 (1,428.61–1,787.18)	3.77 (2.92–4.87)
31–44 years	78,030	599	119,453.07	501.45 (461.29–541.61)	77,222	1,574	130,181.10	1,209.08 (1,149.35–1,268.82)	2.41 (2.19–2.65)
45–54 years	119,356	1,300	197,277.31	658.97 (623.15–694.79)	118,355	2,839	212,090.87	1,338.58 (1,289.34–1,387.82)	2.03 (1.90–2.17)
55–64 years	90,942	1,286	151,221.24	850.41 (803.93–896.89)	90,335	2,357	162,847.33	1,447.37 (1,388.94–1,505.80)	1.70 (1.59–1.82)
≥65 years	31,644	762	60,252.34	1,264.68 (1,174.88–1,354.48)	31,476	1,243	65,356.48	1,901.88 (1,796.15–2,007.61)	1.50 (1.37–1.65)
Sex
Female	147,073	2,179	237,325.48	918.15 (879.60–956.70)	145,557	4,387	258,394.28	1,697.79 (1,647.55–1,748.03)	1.85 (1.76–1.95)
Male	186,456	1,840	307,763.11	597.86 (570.54–625.18)	185,185	3,935	331,299.16	1,187.75 (1,150.64–1,224.86)	1.99 (1.88–2.10)

↵*Biliary disease was defined as occurrence of cholelithiasis, acute cholecystitis, or cholecystectomy. Patients with biliary disease (n = 2,911 from the nondiabetic cohort and n = 5,173 from the type 2 diabetic cohort) or chronic cholecystitis (n = 452 from the nondiabetic cohort and n = 890 from the type 2 diabetic cohort) during the 1-year baseline period were excluded from the numerator and the denominator. Note that some patients may have had more than one exclusionary event.