# Association of Diabetes Mellitus and COVID-19-Related Pancreatic and Biliary Inflammatory Diseases

## TL;DR

This study finds that people with type 2 diabetes are at higher risk of pancreatitis and death from COVID-19 compared to those without diabetes.

## Contribution

The study is the first to use multinational real-world data to show a link between pre-existing type 2 diabetes and increased risk of acute pancreatitis and mortality in COVID-19 patients.

## Key findings

- Patients with type 2 diabetes had a 30.7% higher risk of acute pancreatitis during COVID-19.
- Mortality risk was 14.1% higher in patients with type 2 diabetes compared to those without.
- Cholecystitis risk was slightly increased, but cholangitis risk was not significant.

## Abstract

Background/Objectives: The COVID-19 pandemic has brought about significant clinical challenges in regard to digestive systems, as well as causing complications such as pancreatitis and biliary infections. Whether diabetes mellitus (DM) contributes to both an increased risk for these complications and mortality amongst COVID-19 patients remains to be investigated. This study aimed to illuminate any possible outcomes, including pancreatitis, cholangitis, cholecystitis and all-cause mortality, among COVID-19 patients with and without pre-existing type 2 diabetes mellitus (T2DM), using real-world data taken from a multinational electronic health record database. Methods: A retrospective cohort study based upon data taken from the database of the TriNetX Global Collaborative Network was conducted. We included patients from the database who had been diagnosed with COVID-19 from January 2020 to December 2023. Enrolled subjects were divided into two cohorts: COVID-19 patients with pre-existing T2DM who had had at least two medical visits, and those without T2DM. Propensity score matching was performed using 68 baseline variables. Outcomes were evaluated within 90 days following COVID-19 diagnosis, with patients with prior relevant diagnoses being excluded. Risk analyses, Kaplan–Meier survival estimates, and hazard ratios were calculated as the outcomes. Results: The incidence of acute pancreatitis was significantly higher in the DM+ group when compared to the DM– group (Hazard ratio (HR) = 1.307; 95% confidence interval (CI) 1.048–1.630, p = 0.017) and mortality (HR = 1.141; 95% CI 1.102–1.181, p < 0.05) by Kaplan–Meier analysis. Risk of cholecystitis (HR = 1.264; 95% CI 1.042–1.533, p = 0.017) was borderline increased, and cholangitis was not significant (HR 0.847, 95% CI 0.583–1.230) Conclusions: In COVID-19 patients, pre-existing T2DM is independently associated with increased risks of acute pancreatitis and mortality.