Perioperative glycemic control using an artificial endocrine pancreas in patients undergoing total pancreatectomy: Tight glycemic control may be justified in order to avoid brittle diabetes

Hanazaki, Kazuhiro; Yatabe, Tomoaki; Kobayashi, Masaki; Tsukamoto, Yuuki; Kinoshita, Yoshihiko; Munekage, Masaya; Kitagawa, Hiroyuki

doi:10.3233/bme-120736

Cited by 10 publications

(4 citation statements)

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“…As a result, perioperative IIT using an AP can be used not only to prevent hypoglycemia less than 70 mg/dL but also to maintain stable glycemic control with less variability of blood glucose levels (Figure 5). In addition, IIT using an AP enabled us to achieve stable glycemic control in patients undergoing total pancreatectomy for the most serious diabetic status, called brittle diabetes due to pancreatogenic diabetes, not only without hypoglycemia or hyperglycemia, but also with low blood glucose variability in accordance with the time in range 28 . These results were compatible with that of our experimental study in the United States 27 .…”

Section: Current Bedside Ap Stg‐55 With Closed‐loop Systemsupporting

confidence: 87%

“…In addition, IIT using an AP enabled us to achieve stable glycemic control in patients undergoing total pancreatectomy for the most serious diabetic status, called brittle diabetes due to pancreatogenic diabetes, not only without hypoglycemia or hyperglycemia, but also with low blood glucose variability in accordance with the time in range. 28 These results were…”

Section: Gastroenterological Surgerymentioning

confidence: 75%

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Closed‐loop artificial endocrine pancreas from Japan

et al. 2021

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The development of a closed‐loop artificial pancreas (AP) in the Western countries and Japan is different. In Western countries, wearable AP with a closed‐loop glycemic control system has been developed as a treatment for patients with type 1 and type 2 diabetes. On the contrary, in Japan, bedside closed‐loop AP explored by a Japanese company (Nikkiso, Tokyo, Japan) has developed as perioperative glycemic control device in surgical patients and acute care patients with emergency. In this article, we reviewed the scientific evidence in the past and present and future prospects of perioperative glycemic control using bedside AP with a closed‐loop system in Japan. Conventional perioperative strict glycemic controls have three major problems: hyperglycemia, hypoglycemia, and variability in blood glucose concentrations. In Japan, perioperative strict glycemic control using the current bedside AP STG‐55 (Nikkiso, Tokyo, Japan) has been developed since 2010. This novel glycemic control method achieved not only stable glycemic control without hyperglycemia, hypoglycemia, and less variability of blood glucose concentrations but also reduced postoperative infectious complications in patients undergoing major surgeries. Among the rapidly increasing number of surgical or emergency patients with diabetes, frailty, and sarcopenia of intrinsic glucose intolerance, more sophisticated and smaller AP available easily in operating rooms and intensive care units will be warranted to promote improved therapeutic outcomes in such critically ill patients.

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Section: Current Bedside Ap Stg‐55 With Closed‐loop Systemsupporting

confidence: 87%

Section: Gastroenterological Surgerymentioning

confidence: 75%

Closed‐loop artificial endocrine pancreas from Japan

et al. 2021

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“…Closed-loop insulin pumps have been successfully used peri-operatively in individuals undergoing pancreatic resection, achieving glycaemic control without hypoglycaemia ( 6 ). A randomised study of 30 people post pancreatic resection demonstrated significantly improved glycaemic control peri-operatively in the closed-loop insulin pump group compared to multiple daily injection, with no difference in hypoglycaemia rates ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Sensor-augmented CSII therapy with predictive low-glucose suspend following total pancreatectomy

Scott

Fulcher

Clifton-Bligh

2017

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Pancreatogenic diabetes is characterised by recurrent severe hypoglycaemia due to changes in both endocrine and exocrine functions. There are no guidelines to manage these individuals. Herein, we describe the post-operative management of two people who developed pancreatogenic diabetes following total pancreatectomy for neuroendocrine malignancy. In both individuals, diabetes was managed using sensor-augmented predictive low-glucose suspend continuous subcutaneous insulin infusion (CSII). We demonstrate the benefit of sensor-augmented CSII in averting hypoglycaemia whilst optimising glycaemic control. Expected rates of severe hypoglycaemia in individuals with pancreatogenic diabetes can be averted with the use of continuous glucose monitoring (CGM) technology, optimising quality of life and reducing the risk of diabetes-related complications.Learning points:There are no clear guidelines to manage people with pancreatogenic diabetes.We describe the use of CGM with predictive low-glucose suspend continuous subcutaneous insulin infusion (CSII) in the management of two individuals post-pancreatectomy.Predictive low-glucose suspend technology can achieve excellent glycaemic control whilst avoiding recurrent and severe hypoglycaemia in people with pancreatogenic diabetes.Predictive low-glucose suspend CGM should be considered as an effective therapeutic option for the management of pancreatogenic diabetes.

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“…We identified no difference in glycemic control or insulin dose between the CSII group and the MDI group, but Struyvenberg et al (26) demonstrated a significant reduction in severe hypoglycemic events in the CSII group than in the MDI group. Additionally, it was reported that artificial pancreas, sensoraugmented predictive low-glucose suspend pump and advanced hybrid closed−loop systems were efficacious and safe for perioperative and long-term glycemic control after TP (39)(40)(41). Hence, advanced techniques in diabetes care, including CGM, CSII, and new insulin preparations, can potentially allow better glycemic control in patients after TP.…”

Section: Discussionmentioning

confidence: 99%

Diabetes management in patients undergoing total pancreatectomy: A single center cohort study

et al. 2023

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BackgroundTotal pancreatectomy (TP) has been increasingly performed in recent years. However, studies on diabetes management after TP during different postoperative periods are still limited.ObjectivesThis study aimed to evaluate the glycemic control and insulin therapy of patients undergoing TP during the perioperative and long-term follow-up period.MethodsNinety-three patients undergoing TP for diffuse pancreatic tumors from a single center in China were included. Based on preoperative glycemic status, patients were divided into three groups: nondiabetic group (NDG, n = 41), short-duration diabetic group (SDG, preoperative diabetes duration ≤12 months, n = 22), and long-duration diabetic group (LDG, preoperative diabetes duration >12 months, n = 30). Perioperative and long-term follow-up data, including the survival rate, glycemic control, and insulin regimens, were evaluated. Comparative analysis with complete insulin-deficient type 1 diabetes mellitus (T1DM) was conducted.ResultsDuring hospitalization after TP, glucose values within the target (4.4-10.0 mmol/L) accounted for 43.3% of the total data, and 45.2% of the patients experienced hypoglycemic events. Patients received continuous intravenous insulin infusion during parenteral nutrition at a daily insulin dose of 1.20 ± 0.47 units/kg/day. In the long-term follow-up period, glycosylated hemoglobin A1c levels of 7.43 ± 0.76% in patients following TP, as well as time in range and coefficient of variation assessed by continuous glucose monitoring, were similar to those in patients with T1DM. However, patients after TP had lower daily insulin dose (0.49 ± 0.19 vs 0.65 ± 0.19 units/kg/day, P < 0.001) and basal insulin percentage (39.4 ± 16.5 vs 43.9 ± 9.9%, P = 0.035) than patients with T1DM, so did those using insulin pump therapy. Whether in the perioperative or long-term follow-up period, daily insulin dose was significantly higher in LDG patients than in NDG and SDG patients.ConclusionsInsulin dose in patients undergoing TP varied according to different postoperative periods. During long-term follow-up, glycemic control and variability following TP were comparable to complete insulin-deficient T1DM but with fewer insulin needs. Preoperative glycemic status should be evaluated as it could guide insulin therapy after TP.

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Perioperative glycemic control using an artificial endocrine pancreas in patients undergoing total pancreatectomy: Tight glycemic control may be justified in order to avoid brittle diabetes

Cited by 10 publications

References 0 publications

Closed‐loop artificial endocrine pancreas from Japan

Closed‐loop artificial endocrine pancreas from Japan

Sensor-augmented CSII therapy with predictive low-glucose suspend following total pancreatectomy

Diabetes management in patients undergoing total pancreatectomy: A single center cohort study

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