Glucose-lowering therapy in diabetes of the exocrine pancreas: a real-world evidence analysis in a tertiary hospital in the timeframe 2018-2022.

BACKGROUND: Diabetes of the exocrine pancreas (DEP) is a form of diabetes that arises in the presence of an exocrine pancreas disease and is mainly associated with acute and chronic pancreatitis. Therapeutic management of DEP has not changed over the past decades, and treatment is mostly insulin based. However, type 2 diabetes (T2D) treatment guidelines have changed with the aim of normalizing glucose levels and preventing diabetes-related comorbidities. OBJECTIVES: The aim of this study was to evaluate real-word practice in the treatment of diabetes associated with pancreatitis, with a focus on individuals who had already developed cardiovascular and/or renal diseases. DESIGNS: We conducted a cross-sectional observational study on adult patients admitted to a tertiary-level hospital in Italy between 2018 and 2022 with a prevalent diagnosis of pancreatitis and diabetes. METHODS: Disease-related real-world data were collected from Hospital Information Systems using automated data extraction strategies and through the implementation of a patient-centered data repository. A multiple source real-world evidence-based methodology was used to identify patients with diabetes and to investigate changes in glucose-lowering treatments through hospitalizations. RESULTS: We identified 2146 hospitalized patients with pancreatitis from 2018 to 2022, 675 (31.4%) of whom also had diabetes. Data on glucose-lowering therapies were available for 444 of these patients. Individuals with diabetes and pancreatitis were predominantly male (65.2%) and older than those without diabetes (p < 0.001). At hospital admission, 41.9% were on insulin therapy and 44.4% on other drugs, with metformin being the most prescribed. After hospitalization, insulin use increased significantly (61.2%, p < 0.001) while metformin prescriptions decreased (from 44.7% to 26.2%, p < 0.001). Patients with cardiorenal comorbidities showed similar therapeutic patterns, with a pronounced post-discharge reduction in metformin use. CONCLUSION: This real-world study provides updated evidence on the treatment of diabetes associated with pancreatitis in a tertiary care setting, showing a predominant use of insulin and metformin regardless of comorbidities. Despite emerging evidence on the benefits of non-insulin therapies in T2D, such approaches are not yet reflected in the management of DEP, underlining the need for specific clinical guidelines and dedicated trials.