Cleveland Clinic Foundation Warrensville Heights, OH
Farhan M. Qayyum, DO, MA1, Mohannad Abou Saleh, MD2, Woan Kim, DO2, Motasem Alkhayyat, MD2, Alaa Habash, MD2, Ashraf Almomani, MD2, Carlos Roberto Simons-Linares, MD, MSc2, Ari Garber, MD1, Prabhleen Chahal, MD2; 1Cleveland Clinic Foundation, Warrensville Heights, OH; 2Cleveland Clinic Foundation, Cleveland, OH
Introduction: The incidence of pancreatic cyst (PC) has increased tremendously over the last 40 years. Several cysts carry a malignant potential. Although diabetes mellitus (DM) is a known risk factor for developing pancreatic cancer, there is currently no established relationship between DM and PC. We investigated the prevalence of PC in patients with DM and identified underlying associations using a large national database. Methods: This cohort study reviewed de-identified patient data that was entered into a secure HIPAA enabled platform (Explorys Inc. Cleveland, OH, USA) by 26 healthcare systems in the United States. All patient categories for the study were obtained from an overall pool of 39,398,710 patient records between 2015 and 2020. Cohorts were selected using Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnoses of PC and DM. Pancreatitis and pancreatic pseudocysts were excluded. Within the DM cohort, patients who were found to have new PC diagnosis after at least 30 days of DM diagnosis were selected. Prevalence rates were calculated, and underlying associations were identified. Results: Out of 39,398,710 patients in the database (2015-2020), we identified 25,840 (0.07%) with PC and 3,727,990 (9.46%) with DM. Amongst patients with DM, 6,050 (0.16%) were found to have a new diagnosis of PC after at least 30 days of DM diagnosis. Patients with DM were more likely to have a diagnosis of PC when compared to those without DM [OR: 3.47; 95% CI: 3.37-3.57]. Patients with DM who developed PC were more likely to be African American, males, older than 65, with history of smoking, obesity, hypertension, hyperlipidemia, coronary artery disease (Table 1). When compared to DM patients without PC, patients with PC were more likely to use both subcutaneous antihyperglycemics (insulin) and oral antihyperglycemics (metformin and glipizide) (Table 1). Prevalence of PC in DM over time is presented in Figure. Discussion: This is the largest study to date to evaluate the relationship between DM and PC. Patients with DM were ~3.5 times more likely to have PC when compared to those without history of DM. Several other comorbidities such as coronary artery disease, obesity and hypertension were associated with increased risk of PC in DM. This may be explained by increased healthcare utilization by this cohort of patients and increased rate of imaging, chronic inflammation, increased levels of insulin-like growth factor, and changes in the microbiome my also play a role.
Odds ratio of associated risk factors of pancreatic cysts in diabetes mellitus
Figure. Proportion of Pancreatic Cysts after Diabetes Mellitus Diagnosis
Disclosures: Farhan Qayyum indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Woan Kim indicated no relevant financial relationships. Motasem Alkhayyat indicated no relevant financial relationships. Alaa Habash indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Carlos Roberto Simons-Linares indicated no relevant financial relationships. Ari Garber indicated no relevant financial relationships. Prabhleen Chahal indicated no relevant financial relationships.