ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
This article is part of the Research TopicAcute Pancreatitis Infection: Epidemiology, Prevention, Clinical Characteristics, Treatment, and Prediction: Volume IIView all 7 articles
Risk stratification and predictive value of glucose variability for the development of post-acute pancreatitis diabetes mellitus
Provisionally accepted
Suwan Qian1
Yang Liu2
Wei Wang1Wenji Ni1
Shuna Zhao3Yixin Xu1
Weiqin Li1Ping Gu1*
Wenkui Yu4*
Zhihui Tong1*- 1Affiliated Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
- 2School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
- 3Nanjing Medical University, Nanjing, Jiangsu Province, China
- 4School of Medicine, Nanjing University, Nanjing, Liaoning Province, China
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Background: To assess whether glucose variability (GV) during acute pancreatitis (AP) predicts post-acute pancreatitis diabetes mellitus (PPDM-A), significantly affecting patient life quality. Methods: This study was performed during 2016-2020 at Jinling Hospital, with a 3-year follow-up for each patient. Cox proportional hazards model was used to evaluate the association of GV with the possibility of developing PPDM-A. Dose-response relationships of GV with the three-year probability of PPDM-A were characterized based on a restricted cubic splines (RCS) model. GV was analyzed to predict the ability for PPDM-A by calculating area under the receiver operating characteristic curves (AUCs). Results: PPDM-A rates rose from 16% at one year to 27.3% at three years post-AP. Multivariate Cox analysis indicated that the largest amplitude of glycemic excursions (LAGE) exhibited independent association with an increased PPDM-A risk within 3 years (HR =1.21, 95% CI: 1.05–1.38, P <0.01). RCS results identified optimum LAGE threshold as 5.1, with significantly higher 3-year PPDM-A rates of abnormal LAGE group (LAGE ≥5.1 mmol/L) when compared with normal LAGE group (LAGE <5.1 mmol/L, P <0.001). AUCs for LAGE in predicting PPDM-A incidence in 12, 24, and 36 months were 0.883 (95% CI: 0.862–0.930), 0.916 (95% CI: 0.887-0.945), and 0.926 (95% CI: 0.895-0.948), respectively. Conclusions: LAGE in hospital stay accurately predicts PPDM-A. Further investigation plays an essential role in determining whether GV-targeting interventions can confer favorable clinical outcomes.
Keywords: acute pancreatitis, Post-acute pancreatitis diabetes mellitus, Glucose variability, risk stratification, Largest Amplitude of Glycemic Excursions
Received: 25 Sep 2024; Accepted: 13 Nov 2025.
Copyright: © 2025 Qian, Liu, Wang, Ni, Zhao, Xu, Li, Gu, Yu and Tong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ping Gu, guping@nju.edu.cn
Wenkui Yu, yudrnj2@163.com
Zhihui Tong, njzyantol@hotmail.com
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