Introduction

Acute pancreatitis, an inflammatory condition of the pancreas often caused by gallstones or alcohol abuse, typical manifestations include sudden and severe epigastric pain radiating to the back, nausea and vomiting and epigastric tenderness. Chronic pancreatitis is characterized by progressive inflammation that results in irreversible damage to the structure and function of the pancreas. In recent years, the topic of post-pancreatitis diabetes mellitus PPDM, also known as type 3c diabetes, has received a lot of attention from researchers. PPDM represents long-term sequelae of pancreatitis and is the most common exocrine pancreatic disease. There is a significant lack of knowledge among practitioners about the diagnosis, complications and management of PPDM. Rapid and correct diagnosis of this condition has far-reaching implications including patient counseling, generation of better management strategies to improve blood glucose control, to decrease short-and long-term complications and to increase patient and provider satisfaction. Service, reducing burnout among treating physicians.¹

Aim of the study

Diabetes mellitus after pancreatitis is one of the most common types of secondary diabetes. In this study, we aimed to find out the percentage of patients who had secondary diabetes as a complication of pancreatitis.²

Materials and Methods

A cross-sectional study in Damascus hospital, in the department of gastroenterology included 215 cases from 2017 to 2023.

Inclusion criteria

Records of patients admitted to the division of gastroenterology.

Exclusion criteria

Archive errors, records missing information.³ Cases discharged at the patient's responsibility.

Data collection tool

A questionnaire containing several questions serving the purpose of research was prepared and included in the appendix section at the end of the study.

Statistical analysis: Patients data was tabulated and entered into the computer and then the statistical package for social sciences SPSS version (26) was used to analyze this data and the following statistical methods were relied upon in the analysis.

Descriptive analysis

It consists in finding the relative frequency distributions of the categorical variables of the study (gender, place of residence) and adding graphic forms to enrich the results.

Inferential analysis: This part of the analysis aims to present and interpret the results and infer them in order to reach the goal of the study, by conducting the chi square independence test to study whether there is a relationship between two descriptive variables, by applying the chi square statistic.⁴

Results

Table 1 shows the distribution of the sample, which amounted to 215 cases, according to gender, age and place of residence, where the percentage of males was 116 (54%), more than half of the sample, compared to females 99 (46%), and with regard to age, the average age of the sample was approximately 45 years with a standard deviation of 19.44.The highest recorded age was 87 years, compared to 5 years as the youngest recorded age. As for the place of residence, the governorate of Rif Dimashq had the largest percentage, reaching 108 (50.2%) and the governorate of Rif Dimashq ranked second, with a rate of 61 (28.4%), while the governorate of Homs had the lowest percentage 4 (1.4%).⁵

Table 1: The distribution of the sample, which amounted to 215 cases, according to gender.

Table 2 shows the distribution of the sample according to alcohol consumption, as more than half of the sample are non-alcoholics, with a percentage of 194 (90.2%), compared to alcoholics, whose percentage was only 21 (9.8%).

Table 2: The distribution of the sample according to alcohol consumption.

Table 3 shows the distribution of the sample according to smoking habit. More than half of the sample were also non-smokers, with a percentage of 117 (54.4%), compared to 96 (44.7%) of smokers.

Table 3: The distribution of the sample according to smoking habit.

Table 4 shows the distribution of the sample according to surgical histories, as more than half of the sample had surgical histories and their percentage reached 120 (55.8%), compared to the rest of the sample 94 (43.7%).

Table 4: The distribution of the sample according to surgical histories.

Table 5 shows the distribution of the sample according to their suffering from obesity, as more than half of the sample 154 (71.6%) did not suffer from high BMI.

Table 5: The distribution of the sample according to their suffering from obesity.

Table 6 presents the family history of the study sample, where more than half of the sample had no family history, and they amounted to 153 (71.2%). As for the family history that was recorded, high blood pressure had the largest share at a rate of 33 (15.3%) and the disease came in second place. diabetes by 25 (11.6%).^6,7

Table 6: The family history of the study sample.

Table 7 shows the radiographic investigations used in the context of managing a case of pancreatitis, where ultrasound was the most used method with a percentage of 207 (27.3%) and the ERCP came in second place with a percentage of 118 (17.50%), followed by a Chest X-Ray simple (CXR) with a rate of 132 (17.40%), while Magnetic Resonance Imaging (MRI) was the least used method with a rate of 7 (0.9%).

Table 7: The radiographic investigations used in the context of managing a case of pancreatitis.

Table 8 shows the distribution of the sample according to the presence of medical history and more than half of the sample had suffered from medical history and their percentage was 139 (64.7%), compared to the rest of the sample who did not suffer from medical history and their percentage was 76 (35.3%).

Table 8: The distribution of the sample according to the presence of medical history.

Table 9 shows the distribution of the sample according to complications of pancreatitis and the percentage of those who had complications was 114 (53%), compared to 101 (47%) who did not.

Table 9: The distribution of the sample according to complications of pancreatitis.

Table 10 shows the distribution of the sample according to the appearance of diabetes symptoms after pancreatitis and more than half of the sample did not have any symptoms and their percentage reached 156 (72.6%), compared to those who had symptoms and their percentage was 59 (27.4%).^8,9

Table 10: The distribution of the sample according to the appearance of diabetes symptoms after pancreatitis.

Table 11 shows a study of the relationship between the occurrence of complications of pancreatitis and the emergence of symptoms of diabetes, as the significance of the test was less than 0.05 (P-Value<0.05), meaning that with 95% confidence there is a real, statistically significant relationship between pancreatitis and the occurrence of diabetes as a complication for him, the percentage of patients who showed symptoms of diabetes was 50 (23.3%).^10,11

Table 11: A study of the relationship between the occurrence of complications of pancreatitis and the emergence of symptoms of diabetes.

Discussion

Unlike type 1 and type 2 diabetes, the epidemiology of PPDM was relatively unknown until the past decade, prevalence is still likely to be lower than expected and may be expected to rise with increased awareness.¹² The prevalence of PPDM is significantly higher in men than in women in both acute and chronic pancreatitis and this was shown in the context of our study, as the incidence of males was (54%), while the incidence of females was (46%).

The small sample size may play a role in not giving accurate information about the habits followed that may have a role in the occurrence of pancreatitis, as a small percentage of the patients were alcoholics (9.8%) and less than half were smokers (44.7%).

Long-term complications of PPDM include abdominal pain, pancreatic exocrine insufficiency, malnutrition, decreased bone mineral density, pseudocysts, visceral vascular complications, diabetes mellitus and pancreatic cancer which was demonstrated in the course of our study where more than half of the patients they had complications of pancreatitis (53%).^13-15

Conclusion

When studying the relationship between the occurrence of pancreatitis and the development of diabetes, it was found that there is a real relationship with statistical significance and with confidence of 95%, as the percentage of patients who showed symptoms of diabetes reached 50 (23.3%).

It was found that less than half of the patients who suffered complications from pancreatitis suffered from symptoms of diabetes (27.4%), although there is a relationship between pancreatitis and the development of diabetes and it is likely that the small sample size also played a role in that.

Declarations Ethical Statement

The ethical consent was obtained from Syrian private university ethical committee.

Competing Interests

The authors declare no competing of interests.

Availability of Data and Materials

All data are available from the corresponding author on reasonable request.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-forprofit sectors.

References

1. Prtrov MS. Diagnosis of endocrine disease: Post-pancreatitis diabetes mellitus: Prime time for secondary disease. Eur J Endocrinol. 2021;184: R137-R149.

   [Crossref][Google Scholar][PubMed]

2. Petrov MS, Basina M. Diagnosis of endocrine disease: Diagnosing and classifying diabetes in diseases of the exocrine pancreas. Eur J Endocrinol. 2021;184: R151- R163.

   [Crossref][Google Scholar][PubMed]

3. Woodmansey C, McGovern AP, McCullough KA, et al. Incidence, demographics and clinical characteristics of diabetes of the exocrine pancreas (type 3c): A retrospective cohort study. Diab Care. 2017;40:1486-1493.

   [Crossref][Google Scholar][PubMed]

4. Pendharkar SA, Mathew J, Petrov MS, et al. Age-and sex-specific prevalence of diabetes associated with diseases of the exocrine pancreas: A population-based study. Dig Liver Dis. 2017;49:540-544.

   [Crossref][Google Scholar][PubMed]

5. Vujasinovic M, Dugic A, Maisonneuve P, et al. Risk of developing pancreatic cancer in patients with chronic pancreatitis. J Clin Med. 2020;9:3720.

   [Crossref][Google Scholar][PubMed]

6. Vujasinovic M, Dugic A, Nouri A, et al. Vascular complications in patients with chronic pancreatitis. J Clin Med. 2021;10:3720.

   [Crossref][Google Scholar][PubMed]

7. Vujasinovic M, Dugic A, Nouri A, et al. Vascular complications in patients with chronic pancreatitis. J Clin Med. 2021;10:3720.

   [Google Scholar][PubMed]

8. Petrov MS. Diagnosis of endocrine disease: Post-pancreatitis diabetes mellitus: Prime time for secondary disease. Eur J Endocrinol. 2021;184:R137-49.

   [Crossref][Google Scholar][PubMed]

9. Medagama AB, Bandara R. The use of Complementary and Alternative Medicines (CAMs) in the treatment of diabetes mellitus: Is continued use safe and effective? Nutr J. 2014;13:102.

   [Crossref] [Google Scholar] [PubMed]

10. Johansen JS, Harris AK, Rychly DJ, et al. Oxidative stress and the use of antioxidants in diabetes: Linking basic science to clinical practice. Cardiovasc Diabetol. 2005;4:5.

    [Crossref] [Google Scholar] [PubMed]

11. Zimmet PZ. Diabetes epidemiology as a tool to trigger diabetes research and care. Diabetologia. 1999;42:499-518.

    [Crossref] [Google Scholar] [PubMed]

12. Uprety Y, Asselin H, Boon EK, et al. Indigenous use and bio-efficacy of medicinal plants in the Rasuwa District Central Nepal. J Ethnobiol Ethnomed. 2010;6:3.

    [Crossref] [Google Scholar] [PubMed]

13. Kalekar SA, Munshi RP, Thatte UM, et al. Do plants mediate their anti-diabetic effects through anti-oxidant and anti-apoptotic actions? an in vitro assay of 3 Indian medicinal plants. BMC Complement Altern Med. 2013;13:257.

    [Crossref] [Google Scholar] [PubMed]

14. Hjelm K, Atwine F. Health-care seeking behaviour among persons with diabetes in Uganda: An interview study. BMC Int Health Hum Rights. 2011;11:11.

    [Crossref] [Google Scholar] [PubMed]

15. Dominguez-rodriguez A, Torre- PAJM De, Julia H, et al. Effect of intravenous and intracoronary melatonin as an adjunct to primary percutaneous coronary intervention for acute ST elevation myocardial infarction: Results of the Melatonin Adjunct in the acute myocardial Infarction treated with Angioplasty trial. J Pineal Res. 2017;62.

    [Crossref] [Google Scholar] [PubMed]