Chronic pancreatitis and pancreatogenic type 3c diabetes risk: a systematic review and meta-analysis

Chronic pancreatitis (CP) progressively destroys pancreatic parenchyma and predisposes patients to pancreatogenic type 3c diabetes mellitus (T3cDM).

We conducted a systematic review and meta-analysis of cohort studies enrolling adults with clinically and/or instrumentally confirmed CP and no pre-existing diabetes at baseline.

Systematic review and meta-analysis of cohort studies.

Scopus, Web of Science Core Collection, and PubMed were searched from inception to August 2025. Random-effects models estimated pooled incidence of new-onset diabetes and the proportion requiring insulin. Prespecified subgroup analyses were stratified by follow-up duration (<60 months, 60-120 months, >120 months). Meta-regression explored demographic, behavioral, and clinical moderators.

Nineteen studies met the inclusion criteria and contributed to the primary meta-analysis of incident diabetes after CP. The pooled incidence of diabetes was 30% (95% CI: 27-34; I² = 94.8%), with a prediction interval of 15%-49%. Exploratory follow-up-stratified analysis suggested a time-dependent increase: 18% (95% CI: 14-22) at <60 months, 25% (95% CI: 15-35) at 60-120 months, and 44% (95% CI: 24-66) at >120 months (p for subgroup differences = 0.0184). Among patients who developed diabetes, 59% (95% CI: 46-71; 7 studies; I² = 91.7%) required insulin therapy. Meta-regression did not identify statistically significant study-level moderators, although pancreatic calcification showed a non-significant positive trend.

CP is associated with a substantial and time-dependent incidence of diabetes; however, the pooled estimates should be interpreted cautiously because the included studies were observational and highly heterogeneous. These findings support long-term glycemic monitoring and careful classification of pancreatogenic diabetes in patients with CP, while optimal screening intervals and treatment timing require further prospective evidence.

PROSPERO CRD420251136931.