S0133 Incidence and Predictors of New Onset Diabetes Mellitus Following Surgical Resection of Pancreatic Cystic Lesions

Abstract

INTRODUCTION: There is a risk of new onset diabetes mellitus (NODM) following pancreatic resection. Compared with patients who undergo surgery for other indications, including acute and chronic pancreatitis and pancreatic adenocarcinoma, patients with pancreatic cystic lesions (PCLs) generally have normal adjacent pancreatic parenchyma. However, the risk of post-operative diabetes mellitus (DM) among patients with PCLs is poorly defined. Therefore, the objective of the current study was to characterize the incidence and risk factors associated with NODM following pancreatectomy for PCLs. METHODS: The Truven MarketScan Research Database (2012–2018) was utilized to identify all adult subjects with PCLs and without prevalent DM who underwent a pancreatic resection. Stringent exclusion criteria (Figure 1) were utilized to isolate only those patients without other diseases of the exocrine pancreas. A time to event analysis using Kaplan-Meier curves and multivariable Cox proportional hazards analysis was conducted to identify incidence and risk factors associated with post-operative NODM. RESULTS: Among 311 subjects with PCLs who underwent partial pancreatectomy, the overall risk of post-operative DM was 9.1% (95% CI 6.3%–12.9%) at 6 months, 15.1% (95% CI 11.3%–20.2%) at 1 year, and 20.2% (95% CI 15.3%–26.4%) at 2 years. In a multivariable Cox proportional hazards model, older age (55–64 years, adjusted Hazard Ratio (aHR) 1.97, 95% CI 1.04–3.72 vs. 18–54 years), obesity (aHR 2.63, 95% CI 1.35–5.12), hypertension (aHR 1.79, 95% CI 1.01–3.17) and cardiovascular disease/heart failure (aHR 2.54, 95% CI 1.02–6.28) were independent predictors of post-operative NODM. Moreover, there was no significant difference in risk of NODM after distal pancreatectomy versus pancreaticoduodenectomy (unadjusted HR 1.41, 95% CI 0.69–2.88) in this population. CONCLUSION: In a large population-based cohort, the risk of NODM following pancreatectomy for PCL was not excessive, and was relatively higher in older patients with features of metabolic syndrome and/or cardiovascular disease. Individuals with these clinical characteristics may benefit from peri- and post-operative monitoring, education, and treatment strategies for DM.Figure 1