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Drug boosts survival for diabetes after pancreatitis


A University of Auckland-led study has shown for the first time that diabetes drug metformin halves the risk of death in people with the second most common form of adult-onset diabetes.


Lesser known than its cousins, types 1 and 2 diabetes, ‘diabetes of the exocrine pancreas’ is a form of diabetes caused by the part of the pancreas that produces digestive enzymes. Common contributing causes are pancreatic cancer and pancreatitis, an excruciating inflammation of the pancreas.

This form of diabetes affects at least 10,000 people in Aotearoa New Zealand. People with this form are known to die earlier than those with type 2 diabetes, yet there are no established treatment guidelines and researchers say the condition is under-recognised by doctors.

In the first study of its kind, the University of Auckland’s COSMOS team gathered New Zealand-wide pharmaceutical dispensing data from 2006-2015 and linked it anonymously to the hospital records of 1,862 people with diabetes of the exocrine pancreas.

They found that, in patients with diabetes after pancreatitis (postpancreatitis diabetes), the use of metformin reduced the risk of death by 49 percent compared with patients who had never taken any diabetes drugs. This survival benefit of metformin was even more pronounced than in patients with type 2 diabetes (whose risk of death was reduced by 25 percent). However, in patients with diabetes related to pancreatic cancer, metformin did not boost survival odds.

The results are published in Diabetes Care, the world’s top clinical diabetes journal and the official journal of the American Diabetes Association.

“Strikingly, almost a third - 31 percent - of the people whose records we looked at did not receive any diabetes drug,” says lead author Dr Jaelim Cho, a PhD student in the COSMOS group at the University’s Faculty of Medical and Health Sciences. “It is expected that this population will benefit from metformin use.”

Senior author and principal investigator of the COSMOS group, Associate Professor Max Petrov, says: “Metformin, which is a long-used type 2 diabetes medication that is not expensive and easily available, should now be recommended as the front-line treatment in patients with post-pancreatitis diabetes. For patients with pancreatic cancer-related diabetes, we need more investigations on how to best treat this condition.”

Previous research from the COSMOS group showed that Māori and Pacific adults are at more than double the risk of developing post-pancreatitis diabetes than New Zealand Europeans.

Diabetes Care: Antidiabetic medications and mortality risk in individuals with pancreatic cancer-related diabetes and postpancreatitis diabetes: a nationwide cohort study


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