Declining incidence of hypoglycaemia in diabetes secondary to chronic pancreatitis: A nationwide cohort study from 2003 to 2022

Aims Population‐based studies have consistently shown that individuals with diabetes secondary to chronic pancreatitis (pancreatic diabetes) have a high risk of hypoglycaemia. We aimed to investigate whether this risk has declined over recent years following the introduction of modern glucose‐lowering medications. Materials and Methods In this Danish nationwide population‐based cohort study, we included all adults with new‐onset diabetes between 1998 and 2022 and classified them as having pancreatic diabetes, type 1, or type 2 diabetes. We examined annual incidence rates of hypoglycaemia leading to hospitalisation, trends in dispensed glucose‐lowering medications, and associations with hypoglycaemia risk. Results Among 583 220 individuals with new‐onset diabetes, 3383 (0.6%) were classified as pancreatic diabetes, 12 383 (2.1%) as type 1 diabetes, and 567 454 (97.3%) as type 2 diabetes. Comparing 2003–2006 to 2019–2022, the incidence of severe hypoglycaemia declined within each diabetes subtype: by 69% in pancreatic diabetes (incidence rate ratio (IRR) 0.33, 95% CI 0.25–0.40), 57% in type 1 diabetes (IRR 0.43, 95% CI 0.38–0.49), and 65% in type 2 diabetes (IRR 0.35, 95% CI 0.33–0.37). This coincided with a shift from human to analogue insulin and an increase in the use of metformin in individuals with pancreatic diabetes. Metformin use was associated with a lower risk of severe hypoglycaemia (adjusted hazard ratio 0.36, 95% CI 0.26–0.48). All types of insulin were associated with higher hypoglycaemia risk; insulin analogues carried a lower risk than human insulin. Conclusion Hospitalisation for hypoglycaemia in pancreatic diabetes has declined substantially over time, alongside notable changes in treatment patterns.