Acute pancreatitis does not end at discharge: the forgotten risk of post-pancreatitis diabetes

Abstract Acute pancreatitis (AP) is traditionally considered an acute inflammatory illness from which patients recover once pain resolves, organ dysfunction improves, and the underlying cause is addressed. However, pancreatic recovery may not be complete at discharge. Increasing evidence indicates that AP is associated with a substantial long-term risk of dysglycemia and post-pancreatitis diabetes mellitus (PPDM), including after mild, non-necrotizing disease. The mechanisms underlying PPDM are heterogeneous and may include loss of pancreatic tissue, inflammation-related β-cell dysfunction, insulin resistance, altered incretin signaling, and impaired insulin secretion. Consequently, a normal glucose concentration at discharge should not be considered evidence of long-term endocrine recovery. The severity of AP and the presence of pancreatic necrosis increase the risk, but restricting surveillance to patients with severe disease may overlook a clinically relevant proportion of patients who subsequently develop dysglycemia. Current international recommendations provide a practical framework for follow-up, with assessment of glucose metabolism approximately 3–6 months after recovery and continued annual assessment thereafter. Patients with severe or necrotizing disease, recurrent AP, metabolic risk factors, or evolving dysglycemia may require closer surveillance. The next challenge is to move beyond simply diagnosing diabetes after AP toward identifying patients at risk before diabetes develops. Acute-phase glycemic patterns may provide prognostic information, although current evidence is insufficient to support routine prediction scores or continuous glucose monitoring for PPDM screening. Further research is needed to determine whether early identification and targeted intervention can alter the metabolic trajectory following AP. Recognition of endocrine recovery as an additional component of recovery from AP may provide an important opportunity to improve long-term patient care.