115-OR: Early Insulin Pump Use in Pediatric Post–Total Pancreatectomy Islet Auto Transplantation Management

Abstract

Objective: Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure for patients with chronic pancreatitis who experience debilitation and poor quality of life. Glucose targets are critical for islet survival. We hypothesized that early transition from intravenous insulin to insulin pump therapy would improve glucose control and impact hospital duration. Research Design and Methods: We performed a retrospective analysis of 40 patients who underwent TPIAT. Prior to 2016, post-operative insulin was delivered intravenously and transitioned to multiple daily injections (MDI) followed by pump administration (n=14). After 2016, post-operative insulin was delivered intravenously followed by early transition to pump therapy (n=26). Outcomes analyzed between groups included: percentage of blood glucoses in target (80-120 mg/dL), hypoglycemia (<60 mg/dL) and hyperglycemia (>140 mg/dL), blood glucose variability, and length of stay after transition off intravenous insulin. Results: Patients with early transition to pump therapy had a higher proportion of glucose values in target range (p=0.0003), a lower proportion of hyperglycemia (p=0.04), and a lower proportion of hypoglycemia, though not significant (p=0.33). In patients with early pump transition, variability in glucose values decreased over the first 10 days post-intravenous insulin (p=0.001) and post-transition median length of stay was shorter by 5 days (p=0.005). Conclusions: Early pump therapy in this population achieved tighter glycemic control and reduced duration of stay. Disclosure S.E. Tellez: None. L. Hornung: None. J.D. Courter: None. M. Abu-El-Haija: None. J.D. Nathan: None. S. Lawson: None. D.A. Elder: None.