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Incidence and Severity of Pancreatogenic Diabetes After Pancreatic Resection

  • 2014 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

While many patients experience prolonged survival after pancreatic resection for benign or malignant disease, the long-term risk of pancreatogenic diabetes mellitus (DM) remains poorly characterized.

Methods

One thousand one hundred seven patients underwent pancreatectomy at Thomas Jefferson University between 2006 and 2013. Attempts were made to contact all living patients by telephone and a DM-focused questionnaire was administered.

Results

Two hundred fifty-nine of 691 (37 %) surviving patients completed the survey, including 179 pancreaticoduodenectomies (PD), 78 distal pancreatectomies (DP), and 2 total pancreatectomies. In the PD group, 44 (25 %) patients reported having DM prior to resection. Of these, 5 (12 %) had improved glucose control after resection and 21 (48 %) reported escalated DM medication requirements post-resection. Of 135 PD patients without preoperative DM, 24 (18 %) had new-onset DM postoperatively. In the DP group, 23 patients (29 %) had DM preoperatively. None had improved glucose control after resection, while six (26 %) had worse control after resection. Seventeen of 55 DP patients (31 %) without preoperative DM developed new-onset DM postoperatively (p = 0.04 vs. PD). Preoperative HgbA1C >6.0 %, glucose >124 mg/dL, and insulin use >2 units per day were associated with an increased risk of new-onset postoperative DM.

Conclusions

The development or worsening of DM after pancreatic resection is extremely common, with different types of resections conveying different risks for disease progression. DP places patients at a greater risk for the development of new-onset postoperative diabetes when compared to PD. In contrast, patients with preoperative diabetes are more likely to experience worsening of their disease after PD as compared to DP. Patients should be screened prospectively, particularly those at highest risk, and informed of and educated about the potential for post-resection DM.

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Acknowledgments

The authors of this manuscript would like to thank the nurses, residents, faculty, and staff of the Thomas Jefferson University Hospital for the excellent care provided to these patients.

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Authors and Affiliations

  1. Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center at Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Richard A. Burkhart, Renee M. Tholey, Kathleen M. Lamb, Caitlin A. McIntyre, Robert F. Felte, Ernest L. Rosato, Harish Lavu, Charles J. Yeo & Jordan M. Winter

  2. Division of Endocrinology, Diabetes and Metabolism, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, USA

    Susan M. Gerber

  3. Division of Endocrinology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Anitha Somasundaram, Eliza C. Fradkin, Annie P. Ashok, Jaya M. Mehta & Serge A. Jabbour

Authors
  1. Richard A. Burkhart
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  2. Susan M. Gerber
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  3. Renee M. Tholey
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  4. Kathleen M. Lamb
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  5. Anitha Somasundaram
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  6. Caitlin A. McIntyre
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  7. Eliza C. Fradkin
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  8. Annie P. Ashok
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  9. Robert F. Felte
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  10. Jaya M. Mehta
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  11. Ernest L. Rosato
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  12. Harish Lavu
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  13. Serge A. Jabbour
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  14. Charles J. Yeo
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  15. Jordan M. Winter
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Corresponding author

Correspondence to Jordan M. Winter.

Electronic supplementary material

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Supplemental Figure 1

Recruitment template: Checklist detailing the specific telephone script used upon contact with each subject. (DOC 39 kb)

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Burkhart, R.A., Gerber, S.M., Tholey, R.M. et al. Incidence and Severity of Pancreatogenic Diabetes After Pancreatic Resection. J Gastrointest Surg 19, 217–225 (2015). https://doi.org/10.1007/s11605-014-2669-z

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  • DOI: https://doi.org/10.1007/s11605-014-2669-z

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