Abstract
Background. Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN) is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C) at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, P = 0.52), 12 months (7.3% versus 8.0%, P = 0.081), 18 months (7.7% and 7.6%, P = 0.64), and at 24 months (7.3% versus 7.8%, P = 0.10)). Seven TP patients (50%) experienced a hypoglycemic event compared to 65 type 1 DM patients (65%, P = 0.38). Limitations. Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.
Highlights
Diabetes mellitus (DM) induced by total pancreatectomy (TP), often termed “Pancreatogenic Diabetes,” is often thought to be difficult to manage [1,2,3,4]
We evaluated trends in HbA1c values over time, separately in TP and type I diabetes mellitus (DM) patients, using mixed effects linear regression models including a random effect for patient
Mucinous adenocarcinoma was noted in one patient, noninvasive carcinoma in eight patients, adenoma in four patients, and one patient had borderline findings for malignancy
Summary
Diabetes mellitus (DM) induced by total pancreatectomy (TP), often termed “Pancreatogenic Diabetes,” is often thought to be difficult to manage [1,2,3,4]. More recent data suggests that glycemic control following TP may not be as challenging as initially thought [6]. IPMN involvement of the main pancreatic duct has been shown to be a risk factor for prevalent and incident cancers and is a leading cause for recommending surgical resection [8]. Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Baseline was defined as 6 months prior to the first HbA1c measure. Small number of TP patients, retrospective design, lack of long-termfollowup. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated
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