Abstract
IntroductionPancreatogenic diabetes after pancreatectomy is of growing importance due to the increasing life expectancy of pancreatectomized patients. Although reduction of pancreatic volume is thought to affect glucose metabolism, a consistent relationship has yet to be determined. This study aimed to investigate functional consequences of distal pancreatectomy (DP) in preoperatively non-diabetic patients. MethodsThis study included 61 non-diabetic patients who underwent DP. Clinical data were obtained, and the percent resected volume (PRV) of each pancreas was determined via multi-detector row computed tomography volumetry. ResultsDuring the follow-up period (median 26 months), 22 patients (36 %) developed new-onset diabetes within a median onset time of 8 months (range 0.5–42 months) postoperatively. The remaining 39 patients also showed impaired glucose metabolism. Multivariate analysis identified preoperative hemoglobin A1c ≥ 5.7 % (odds ratio 15.6, p = 0.001) and PRV > 44 % (odds ratio 11.3, p = 0.004) as independent risk factors for new-onset diabetes. ConclusionsKey determinants of postoperative glycemic control include preoperative functional reserve of the endocrine pancreas and the volume reduction of pancreatic parenchyma. Our findings enable reliable preoperative evaluation of the risk of postoperative diabetes and appropriate postoperative surveillance, which is helpful for early intervention in high risk patients.
Highlights
Pancreatogenic diabetes after pancreatectomy is of growing importance due to the increasing life expectancy of pancreatectomized patients
Nutritional status and pancreatic endocrine functions were assessed based on measurements of body weight, serum albumin, fasting plasma glucose (FPG), and serum hemoglobin A1c (HbA1c)
HbA1c values represent the National Glycohemoglobin Standardization Program (NGSP) equivalent values and in all cases were converted from previous Japan Diabetes Society standard substance and measurement methods (JDS HbA1c, in percent) using the following formula: NGSP HbA1c (%)0JDS HbA1c (%)+0.4 %
Summary
Pancreatogenic diabetes after pancreatectomy is of growing importance due to the increasing life expectancy of pancreatectomized patients. Reduction of pancreatic volume is thought to affect glucose metabolism, a consistent relationship has yet to be determined. This study aimed to investigate functional consequences of distal pancreatectomy (DP) in preoperatively non-diabetic patients. Pancreatogenic diabetes, classified as type 3c by the American Diabetes Association,[1] is associated with diseases of the exocrine pancreas including pancreatitis, benign and malignant neoplasm, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy, and trauma and pancreatectomy. Among the 8–9 % of the general diabetes population with type 3c diabetes in Western countries, 2–3 % are those. No grant support was provided for this study.
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