Diabetes RElated to Acute Pancreatitis and its Mechanisms: Metabolic Outcomes Using Novel CGM Metrics (DREAM-ON) - ABSTRACT / PROJECT SUMMARY Background: Acute pancreatitis (AP) is a common and serious condition, accounting for more than 300,000 hospitalizations and over $2 billion in health care costs per year in the United States alone. Patients with AP have an increased risk of several complications including diabetes (DM). Two recent meta-analyses suggest that AP increases risk of DM by 23-37%, and that the risk increases over time. The pathogenesis of DM following AP has historically been ascribed to the loss of β-cell mass, however other mechanisms, including the development of insulin resistance or β-cell autoimmunity may also play a role. The Type 1 Diabetes and Acute Pancreatitis Consortium (T1DAPC): The overall goals of the T1DAPC are to describe the risk for and mechanisms of diabetes mellitus occurring after one or more episodes of acute pancreatitis. Secondary objectives include defining the natural history of acute pancreatitis, the clinical risk factors that predict development of diabetes and pre-diabetes, the natural history of beta cell function after acute pancreatitis, and the potential contribution of an altered immune state to the increased risk for diabetes after acute pancreatitis. These objectives are being addressed the ongoing, prospective, observational T1DAPC study entitled “Diabetes RElated to Acute Pancreatitis and its Mechanisms (DREAM)”. DREAM-ON: This ancillary study pilot proposal, entitled “Diabetes RElated to Acute Pancreatitis and its Mechanisms: Metabolic Outcomes Using Novel CGM Metrics (DREAM-ON)” which will be conducted in participants enrolled in the DREAM study, will test whether continuous glucose monitoring (CGM) is clinically useful to predict risk for developing diabetes, the need for insulin therapy among those who develop diabetes and whether CGM can provide insight into the diabetes subtype among patients who have experienced an episode of acute pancreatitis. Thus, the results of this ancillary study will complement and extend the primary research questions in the DREAM study. Specific Aims: Aim 1: To perform CGM in all participants in the DREAM study in conjunction with their scheduled visits at months 3, 12, 24 and subsequent annual visits and to determine if CGM metrics predict incident pre-diabetes and DM. Aim 2: To determine if CGM metrics predict need for insulin therapy in patients who develop DM after AP. Aim 3: To determine whether CGM metrics correlate with measures of insulin secretion and insulin resistance derived from the OGTT, MMT and FSIVGTT, and can be used as a surrogate to predict diabetes subtype.
