Letter: Type 2 diabetes prevention after acute pancreatitis

To the Editor: I read with great interest the review article by Dr. Chun and colleagues¹ in the April issue. The authors provide a comprehensive and practical overview of gastrointestinal disorders in patients with diabetes mellitus, highlighting the critical role of primary care clinicians in screening and management.

However, I would like to draw attention to an area that the authors briefly mention but that deserves further emphasis: screening for diabetes after an episode of acute pancreatitis. As noted in the article, about 15% of patients develop diabetes within 1 year of an acute pancreatitis episode, a condition now recognized as type 3c diabetes mellitus, or pancreatogenic diabetes.² Despite this significant risk, the authors correctly state that there are currently no established guidelines for screening for diabetes following acute pancreatitis.

At our institution, we have encountered several barriers to implementing systematic postpancreatitis diabetes screening. First, our electronic health record system does not automatically flag patients with a history of acute pancreatitis for glycemic monitoring, leaving screening to clinician discretion and often resulting in missed opportunities for early diagnosis. Second, there is a lack of awareness among both primary care clinicians and patients that acute pancreatitis can lead to the development of diabetes, distinct from the more common type 2 diabetes. This knowledge gap means that early symptoms of hyperglycemia may be attributed to other causes or overlooked entirely. Third, the transition of care from inpatient hospitalization for acute pancreatitis back to the primary care setting often lacks clear recommendations for follow-up glycemic screening intervals.³

Further research is urgently needed to establish evidence-based screening protocols for diabetes after an acute pancreatitis episode. Such guidelines could specify optimal screening intervals and methods (eg, hemoglobin A1c, fasting glucose, or oral glucose tolerance testing) and clarify which patient populations are at highest risk. In the interim, we recommend that primary care clinicians consider screening all patients for diabetes at 3 to 6 months after an acute pancreatitis episode, with ongoing annual surveillance thereafter. This proactive approach may facilitate earlier diagnosis and intervention, potentially improving long-term outcomes in this at-risk population.⁴

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