Abstract:
The growing prevalence of type 2 diabetes mellitus (DM) poses substantial health and economic burden to patients and healthcare systems. While it is well-recognised in the general population, another subgroup, known as pancreatogenic DM is gaining attention as a unique clinical entity. Current research indicates that patients with diseases of the exocrine pancreas, particularly after an episode of acute pancreatitis (AP), are at a greater risk of developing DM. However, the lack of awareness regarding the risk of DM after AP, in patients and healthcare providers alike, has resulted in a lack of guidelines to instigate DM risk assessment and follow-up of patients after hospitalisation. The first aim of this thesis was to evaluate the characteristics of screening scores for type 2 DM. Secondly, this thesis aimed to investigate and identify the risk factors for abnormal glucose metabolism after an episode of AP. From this, the third aim was to develop a screening score that can be readily used by patients to assess and monitor their risk of developing DM after AP. This thesis found that screening scores might prove useful as a self-directed instrument to assess and monitor for risk of developing DM after AP. Literature shows that screening scores are relatively inexpensive compared to other screening methods, and are easily accessible and practical instruments for patient use. Further, this research identified 9 potential risk factors that are significantly associated with abnormal glucose metabolism after an episode of AP. These include age, sex, waist circumference, smoking status, history of high blood glucose levels, usage of anti-hypertensive medications, as well as aetiology, recurrence, and severity of AP. Based on these factors, a screening score, called PERSEUS (prediabetes self-assessment screening score after acute pancreatitis), was developed and validated with a view to identifying individuals after AP who are at high risk of developing new onset DM after hospital discharge. This will pave the way to preventing pancreatogenic DM in general, and DM after AP in particular.