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OBJECTIVE The objective of this study was to assess the risk of acute pancreatitis in
patients with type 2 diabetes compared with that in patients without diabetes. We also examined
the risk of biliary disease (defined as occurrence of cholelithiasis, acute cholecystitis, or cholecystectomy), which is a major cause of pancreatitis.
RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study
using a large, geographically diverse U.S. health care claims database. Eligible patients (18
years) were enrolled for at least 12 continuous months (1999 2005), with no incident events of
pancreatitis or biliary disease during that 1 year baseline period. ICD-9 codes and prescription
data were used to identify patients with type 2 diabetes; ICD-9 codes were also used to identify
cases of pancreatitis and biliary disease. Overall, 337,067 patients with type 2 diabetes were
matched on age and sex with 337,067 patients without diabetes. Incidence rates of disease and
95% CI were calculated per 100,000 person-years of exposure.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby
marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
834
RESULTS The type 2 diabetic cohort had a 2.83-fold (95% CI 2.613.06) greater risk of
pancreatitis and 1.91-fold (1.84 1.99) greater risk of biliary disease compared with the nondiabetic cohort. Relative to patients of corresponding age without diabetes, younger type 2 diabetic
patients had the highest risk of pancreatitis (45 years: incidence rate ratio [IRR] 5.26 [95% CI
4.31 6.42]; 45 years: 2.44 [2.232.66]).
CONCLUSIONS These data suggest that patients with type 2 diabetes may have an
increased risk of acute pancreatitis and biliary disease.
Diabetes Care 32:834838, 2009
From 1Eli Lilly and Company, Indianapolis, Indiana; and 2Amylin Pharmaceuticals, San Diego, California.
Corresponding author: Gary Bloomgren, gary.bloomgren@amylin.com.
Received 24 September 2008 and accepted 17 January 2009.
Published ahead of print at http://care.diabetesjournals.org on 10 February 2009. DOI: 10.2337/dc08-1755.
2009 by the American Diabetes Association. Readers may use this article as long as the work is properly
cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.
org/licenses/by-nc-nd/3.0/ for details.
Enrolled in health plan at any time from 1 January 1999 through 31 December 2005
Total population aged 18 years as of 1 January 2000, continuous enrollment for 1 year
from 1 January 1999 through 31 December 2005
At least 30 days of continuous enrollment from the end of 1-year enrollment
Control cohort: patients without diabetes
No medical claims for diabetes (250.xx) during the study period
No claims for antidiabetes medication during study period
Sex is unknown
Any medical claims during the study period
Study cohort: type 2 diabetes
Claim for type 2 diabetes or antidiabetic medication at any time from 1 January 1999
through 31 December 2005
Claim for type 2 diabetes or antidiabetes medication during the continuous enrollment
period
Medical claim for type 2 diabetes (250.x0 or 250.x2) during the continuous enrollment
period
Claim for antidiabetes medication during the continuous enrollment period
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
Drop patients on insulin-only therapy AND claim for type 1 diabetes (250.x1 or 250.x3)
Sex is known
Matching
Pairs matched 1:1 by sex and age category
Pairs with available claims data
period, they had a claim for type 2 diabetes (250.x0 or 250.x2) and a filled prescription for an antidiabetes medication
(n 386,369). Antidiabetes medications
were defined as biguanides, sulfonylureas,
thiazolidinediones, -glucosidase inhibitors, meglitinides, D-phenylalanine derivatives, pramlintide, exenatide, or insulins.
Patients receiving insulin-only therapy with
a claim for type 1 diabetes (250.x1 or
250.x3) were excluded from the study (n
352,633 patients remaining).
Only patients of known sex were included in either cohort. Cohorts were
pair-matched 1:1 on sex and age (n
352,569). The pairs with available claims
data after matching were used for this
analysis (n 337,067).
Patients with acute pancreatitis (ICD-9
code 577.0), cholelithiasis (574.2x, 574.5x,
574.9x, 576.1x, and 576.2x), acute cholecystitis (574.0x, 574.3x, 574.6x, 574.8x,
575.0, and 575.12), and cholecystectomy
(51.2x) were identified based on the
presence of the relevant diagnosis code
on any medical claim. To ensure that
this was a study of disease incidence,
patients were excluded if they experienced outcome events during the 1-year
baseline period. Specifically, for the
pancreatitis analysis, patients were exDIABETES CARE, VOLUME 32, NUMBER 5, MAY 2009
Patients remaining
Patients removed
29,332,477
12,210,809
17,121,668
9,249,211
2,961,598
8,579,024
8,521,490
8,519,558
6,947,299
670,187
57,534
1,932
1,572,259
1,337,081
640,504
696,577
563,827
76,677
463,046
386,369
100,781
76,677
352,633
352,569
33,736
64
352,569
337,067
15,502
836
*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.
2.59 (2.302.92)
3.02 (2.723.35)
395.28 (371.46419.10)
442.99 (420.52465.46)
267,658.93
337,025.42
148,288
186,642
370
457
148,868
187,542
242,728.54
311,230.74
152.43 (136.90167.97)
146.84 (133.37160.30)
1058
1493
2.83 (2.613.06)
7.75 (3.8915.43)
5.05 (4.106.22)
2.92 (2.553.35)
2.44 (2.132.81)
1.64 (1.361.98)
421.87 (405.50438.24)
409.50 (320.32498.68)
439.11 (403.50474.72)
396.59 (370.11423.07)
432.75 (401.21464.30)
446.02 (395.63496.41)
604,684.35
19,780.12
132,996.11
217,352.86
167,069.73
67,485.52
334,930
13,553
78,051
119,823
91,526
31,977
149.29 (139.11159.46)
52.85 (18.3287.38)
86.93 (70.30103.56)
135.76 (119.62151.89)
177.18 (156.16198.19)
272.27 (231.10313.45)
827
9
105
272
273
168
336,410
13,628
78,518
120,354
91,859
32,051
Overall age
1830 years
3144 years
4554 years
5564 years
65 years
Sex
Female
Male
n*
553,959.28
17,029.62
120,783.10
200,359.38
154,084.70
61,702.48
2,551
81
584
862
723
301
Incident
cases
Incidence rate per 100,000
person-years (95% CI)
Nondiabetic cohort
Person-years of
follow-up
Incident
cases
Table 2Incidence of acute pancreatitis associated with type 2 diabetes stratified by age and sex from a retrospective claims database study, 2000 2005
*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.
1.85 (1.761.95)
1.99 (1.882.10)
1,697.79 (1,647.551,748.03)
1,187.75 (1,150.641,224.86)
258,394.28
331,299.16
4,387
3,935
145,557
185,185
918.15 (879.60956.70)
597.86 (570.54625.18)
2,179
1,840
147,073
186,456
237,325.48
307,763.11
1.91 (1.841.99)
3.77 (2.924.87)
2.41 (2.192.65)
2.03 (1.902.17)
1.70 (1.591.82)
1.50 (1.371.65)
1,411.24 (1,380.921,441.56)
1,607.90 (1,428.611,787.18)
1,209.08 (1,149.351,268.82)
1,338.58 (1,289.341,387.82)
1,447.37 (1,388.941,505.80)
1,901.88 (1,796.152,007.61)
589,693.44
19,217.66
130,181.10
212,090.87
162,847.33
65,356.48
8,322
309
1,574
2,839
2,357
1,243
330,742
13,354
77,222
118,355
90,335
31,476
737.31 (714.52760.11)
426.42 (327.92524.92)
501.45 (461.29541.61)
658.97 (623.15694.79)
850.41 (803.93896.89)
1,264.68 (1,174.881,354.48)
545,088.58
16,884.62
119,453.07
197,277.31
151,221.24
60,252.34
4,019
72
599
1,300
1,286
762
n
n*
333,529
13,557
78,030
119,356
90,942
31,644
Overall age
1830 years
3144 years
4554 years
5564 years
65 years
Sex
Female
Male
Person-years of
follow-up
Incident
cases
Incidence rate per 100,000
person-years (95% CI)
Nondiabetic cohort
Person-years of
follow-up
Incident
cases
Table 3Incidence of biliary disease associated with type 2 diabetes stratified by age and sex from a retrospective claims database study, 2000 2005
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