For the average person, the chance of getting acute pancreatitis is between 5 and 35 in 100,000 per year. The chance of chronic pancreatitis is between 5 and 12 in 100,000 per year. Relative to people without diabetes, people with diabetes have a 1.74-fold increased risk of acute pancreatitis, and 1.4-fold increased risk for chronic pancreatitis.
There are several reasons why this may be, and multiple causes can be present at once.
People with diabetes are more likely to have gallstones than people without diabetes, and these can cause acute pancreatitis. In fact, gallstones are the most common cause for acute pancreatitis in Western countries. The increased risk ranges from 50% up to 17-fold increased risk for acute pancreatitis. Some scientists think that gallstones obstruct the release of bile or substances from the pancreas, and subsequently injure the pancreas, others think gallstones overstimulate parts of the pancreas to cause inflammation of the organ.
People with diabetes commonly have hypertriglyceridemia, or elevated levels of types of fats called triglycerides in their blood. Both individuals with type 1 and type 2 diabetes can have hypertriglyceridemia. When levels of triglycerides rise too high, pancreatitis can result. Lowering triglyceride levels can both prevent and treat pancreatitis caused by hypertriglyceridemia. One way to lower triglycerides is to maintain good control of blood sugar levels. Some individuals are predisposed to higher triglyceride levels based on their genetics.
Type 1 diabetes is an autoimmune condition, and as such, is associated with increased risk of other autoimmune diseases, including autoimmune forms of pancreatitis.
Some diabetes medications may increase the risk of pancreatitis. In particular, the class of medications that target glucagon-like peptide-1 (GLP-1) to control blood sugar levels have been linked to the increased risk. The drugs Januvia (sitagliptin) and Byetta (exenatide) fall into this category. Similarly, antihypertensive medications that people with diabetes frequently take called ACE inhibitors may be related to increased risk of pancreatitis. However, there is not yet consensus on whether the two classes of medications do indeed cause the increased risk for pancreatitis.
Individuals with diabetes are more likely to engage in behaviors that increase risk for pancreatitis, such as alcohol and tobacco use. They are also more likely to experience obesity, which can also predispose to pancreatitis.
Aune D, Mahamat-Saleh Y, Norat T, Riboli E. Diabetes mellitus and the risk of pancreatitis: A systematic review and meta-analysis of cohort studies. Pancreatology. 2020, https://doi.org/10.1016/j.pan.2020.03.019
Aune D, Vatten LJ. Diabetes mellitus and the risk of gallbladder disease: A systematic review and meta-analysis of prospective studies. J Diabetes Complicat. 2016;30(2):368-73.
Cao C, Yang S, Zhou Z. GLP-1 receptor agonists and pancreatic safety concerns in type 2 diabetic patients: data from cardiovascular outcome trials. Endocrine. 2020;
Gonzalez-perez A, Schlienger RG, Rodríguez LA. Acute pancreatitis in association with type 2 diabetes and antidiabetic drugs: a population-based cohort study. Diabetes Care. 2010;33(12):2580-5.
Hartz JC, De ferranti S, Gidding S. Hypertriglyceridemia in Diabetes Mellitus: Implications for Pediatric Care. J Endocr Soc. 2018;2(6):497-512.
Mikó A, Farkas N, Garami A, et al. Preexisting Diabetes Elevates Risk of Local and Systemic Complications in Acute Pancreatitis: Systematic Review and Meta-analysis. Pancreas. 2018;47(8):917-923.
Singh S, Chang HY, Richards TM, Weiner JP, Clark JM, Segal JB. Glucagonlike peptide 1-based therapies and risk of hospitalization for acute pancreatitis in type 2 diabetes mellitus: a population-based matched case-control study. JAMA Intern Med. 2013;173(7):534-9.
Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513-1530.