Exploring the link between fibrates therapy and diabetes mellitus following primary acute pancreatitis with hypertriglyceridemia.

[OBJECTIVE] Post-acute pancreatitis diabetes mellitus (PPDM-A) is a type of diabetes linked to pancreatic exocrine dysfunction, which increases the risk of pancreatic cancer and mortality. Hyperlipidemia, or high blood lipid levels, is the third leading cause of acute pancreatitis (AP) and is associated with a higher diabetes risk. However, the link between lipid-lowering treatments and PPDM-A is unclear. This study aims to explore this relationship.

[METHODS] A cohort of 223 patients diagnosed with AP and hyperlipidemia was categorized into PPDM-A and non-PPDM-A groups. Binary logistic regression was utilized to analyze the correlation between fibrate therapy and PPDM-A incidence. Mendelian randomization (MR) was used to determine whether there was a causal relationship between triglyceride levels and diabetes.

[RESULTS] Elevated blood glucose levels (GLU) (OR=1.360, p<0.001), female (OR=0.091, p=0.030), severity of AP [moderately severe AP (MASP) (OR=5.585, p=0.019)], recurrent acute pancreatitis (RAP) (OR=6.399, p=0.007), and fibrate use (OR=0.109, p=0.001) emerged as independent influencing factors of PPDM-A. MR evidence suggests a causal relationship between triglyceride levels and diabetes risk (OR=1.088, p<0.001), with a two-step MR showing that pancreatitis partially mediates this effect with a mediated proportion of 1.55% (p=0.048).

[CONCLUSION] Fibrates demonstrate the potential to lower the risk of PPDM-A among individuals with AP and hypertriglyceridemia. Furthermore, the effect of triglyceride levels on diabetes risk was partly mediated by pancreatitis.