Pancreatitis: summary of NICE guidanceBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3443 (Published 05 September 2018) Cite this as: BMJ 2018;362:k3443
All rapid responses
The recent NICE guidelines for pancreatitis (1) recommend six monthly HbA1c screening for patients with chronic pancreatitis. We believe diabetes screening should be extended to patients with any history of pancreatic disease, including acute pancreatitis.
We are very grateful to the authors of the guidelines for making use of our analysis of the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database (2,3) to highlight that type 3c diabetes, i.e. ‘pancreatic diabetes’, is often mistaken for type 2 diabetes. In response to their recommendations we have undertaken a new analysis of this database to ascertain how frequently the diagnosis of diabetes is missed entirely.
We find that in UK primary care 59% of patients with a history of pancreatic disease (and without a diabetes diagnosis) had neither a blood glucose nor HbA1c level checked in the previous year. If HbA1c was checked 8% of patients had a result (≥ 48mmol/L) resulting in a new diabetes diagnosis. Populations in which diabetes is rarely considered were especially poorly served: less than four percent of people aged under 35 with pancreatic disease had diabetes testing performed. We feel this demonstrates that a pancreatic disease history merits regular HbA1c screening in primary care.
(1) BMJ 2018 Sept; 362(1687): k3443. https://doi.org/10.1136/bmj.k3443
(2) BMJ Open 2016 April; 6(4): e011092. http://dx.doi.org/10.1136/bmjopen-2016-011092
(3) Diabetes Care 2017 Nov; 40(11): 1486-1493. https://doi.org/10.2337/dc17-0542
Competing interests: No direct funding was received for this research which followed on from CW's NHS academic foundation programme project. CW, KM, and PG have no competing interests. SdeL is director of RCGP RSC, and although not related to this work has received funding for a Diabetes Real World Evidence Centre from Lilly, and project funding from Novo Nordisk, AstraZenca and Sanofi for research projects all through his academic post at University of Surrey.