Use of Insulin and the Risk of Progression of Pancreatitis: A Population-Based Cohort Study

Acute pancreatitis (AP) often progresses to recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). We investigated the relationship between the use of insulin after AP and progression from AP to RAP or CP, as well as the effect of diabetes status on the relationship. Using nationwide pharmaceutical dispensing data and hospital discharge data, insulin-naive individuals were followed from first AP admission. Multivariable time-dependent Cox regression analyses were conducted. In the overall cohort (n = 10,190), ever-use of insulin was associated with an increased risk of progression to RAP or CP (adjusted hazard ratio (HR), 1.70; 95% confidence interval (CI), 1.31-2.20). This risk remained increased in individuals with preexisting diabetes (adjusted HR, 1.45; 95% CI, 1.04-2.00), those with diabetes after AP (3.87; 1.20-12.46), and those without diabetes (2.80; 1.25-6.25). The findings suggest that individuals with AP who receive insulin are at a heightened risk of progression of pancreatitis, irrespective of diabetes status.