Does poorly controlled blood sugar increase the risk of pancreatitis?

From the Guidelines

Poorly controlled blood sugar can increase the risk of pancreatitis, particularly in people with diabetes, as high blood sugar levels over time can damage blood vessels that supply the pancreas and affect its normal function. According to the most recent and highest quality study, people with diabetes are at an approximately twofold higher risk of developing acute pancreatitis 1. The relationship between diabetes and pancreatitis is likely bidirectional, with prediabetes and/or diabetes developing in approximately one-third of individuals after an episode of acute pancreatitis 1.

Some key points to consider in managing blood sugar levels to reduce the risk of pancreatitis include:

• Maintaining good blood sugar control through appropriate medication, diet, regular exercise, and monitoring
• Targeting blood sugar levels between 80-130 mg/dL before meals and below 180 mg/dL after meals, though individual targets may vary based on personal health factors and should be determined with healthcare providers
• Being aware of the potential risks associated with certain diabetes medications, such as GLP-1 receptor agonists, which have been associated with a small increased risk of pancreatitis, though this connection remains somewhat controversial 1.

It is essential to prioritize good blood sugar control and monitoring to reduce the risk of pancreatitis, particularly in people with diabetes. By maintaining target blood sugar levels and being aware of potential risks associated with certain medications, individuals can take steps to minimize their risk of developing pancreatitis.

From the Research

Relationship Between Blood Sugar Control and Pancreatitis

• Poorly controlled blood sugar has been linked to an increased risk of pancreatitis, as evident from a systematic review and meta-analysis of cohort studies 2.
• The study found that diabetes patients are at an increased risk of acute pancreatitis, with a summary relative risk of 1.74 (95% CI: 1.33-2.29) compared to persons without diabetes.
• Another study highlighted the association between diabetes and pancreatitis, suggesting that diabetes represents a group of diseases involving persistent hyperglycaemia, which can be caused or preceded by exocrine disorders of the pancreas, including acute pancreatitis 3.

Impact of Hyperglycemia on Pancreatitis

• A retrospective analysis of patients with acute pancreatitis found that on-admission hyperglycemia predicts a higher inflammatory response, while the presence of hyperglycemia during hospitalization is associated with imaging and biological severity and longer hospitalizations 4.
• The study also found that both on-admission and peak in-hospital hyperglycemia were identified as risk factors for sustained hyperglycemia at follow-up.
• The relationship between blood sugar control and pancreatitis is complex, and further studies are needed to fully understand the pathophysiology and management considerations of diabetes following acute pancreatitis 3.

Management of Blood Sugar Control

• Glycemic control is crucial in managing diabetes, and various therapies, including diet, sulfonylurea, metformin, or insulin, can be used to achieve target fasting plasma glucose concentrations and HbA1c levels 5.
• The choice of therapy depends on various factors, including the patient's age, body mass index, and presence of other comorbidities.
• Sulfonylureas, in particular, are potent glucose-lowering drugs that can be used as second-line treatment for type 2 diabetes, although their use needs to be carefully evaluated due to the risk of hypoglycemia and cardiovascular events 6.