Development of Diabetes after Pancreaticoduodenectomy: Results of a 10-Year Series Using Prospective Endocrine Evaluation

Maxwell, Daniel W.; Jajja, Mohammad Raheel; Tariq, Marvi; Mahmooth, Zayan; Galindo, Rodolfo J.; Sweeney, John F.; Sarmiento, Juan M.

doi:10.1016/j.jamcollsurg.2018.12.042

Cited by 21 publications

(13 citation statements)

References 39 publications

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“…13,30 In the literature, the rate of new-onset diabetes after PD varies between 12% and 22%. [31][32][33][34] In our study, 26% developed this delayed complication. This percentage is quite high as the PD was predominantly carried out in young adults with a low BMI, favoured by the associated IPAA.…”

Section: Discussionmentioning

confidence: 82%

Ten-year impact of pancreaticoduodenectomy on bowel function and quality of life of patients with ileal pouch-anal anastomosis for familial adenomatous polyposis

Collard

Lefèvre

Ahmed

et al. 2020

HPB

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Background: Patients with familial adenomatous polyposis (FAP) carry a risk of duodenal adenocarcinoma. These patients, who already have an ileal pouch-anal anastomosis (IPAA), sometimes require pancreaticoduodenectomy (PD). This work aims to evaluate the long-term consequences of the combination of PD + IPAA.Methods: All patients with IPAA due to FAP who underwent PD from 1991 to 2017 were included (PD + IPAA group). Patients were matched 1:1 according to age, sex, ASA score and presence of colorectal cancer. Fecal continence and quality of life (QoL) were assessed using the Wexner score and the EORTC-QLQ-C30 questionnaire. Results: Thirty-two PD + IPAA patients were matched with thirty-two IPAA-only patients. In each group, the response rate to the questionnaire was 78% (25/32). No differences were noted between PD + IPAA and IPAA-only groups in terms of daytime fecal frequency (6.0 vs 6.0; p = 0.362), Wexner score (3/20 vs 4/20; p = 0.984) and global QoL score (83.3/100 vs 83.3/100; p = 0.401). In the PD + IPAA group, 26% of patients developed diabetes a median period of 10.0 years after PD. The global QoL for these patients was significantly altered (p = 0.011), while daytime fecal frequency was unaffected (p = 0.092) as fecal continence (p = 0.475). Conclusion:In FAP patients with IPAA, PD does not affect bowel function or QoL.

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Section: Discussionmentioning

confidence: 82%

Ten-year impact of pancreaticoduodenectomy on bowel function and quality of life of patients with ileal pouch-anal anastomosis for familial adenomatous polyposis

Collard

Lefèvre

Ahmed

et al. 2020

HPB

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“…A single fasting glucose value was used to calculate estimated HbA1c in patients without a full set of available laboratories, as previously validated. 25…”

Section: Discussionmentioning

confidence: 99%

“…23,24 We previously studied the incidence of NODM after pancreaticoduodenectomy. 25 The primary aim of this study was to define the diabetogenic phenotype and correlate preoperative endocrine evaluation laboratories to new-onset postoperative diabetes and pre-diabetes in patients following DP.…”

Section: Introductionmentioning

confidence: 99%

Diabetes development after distal pancreatectomy: results of a 10 year series

Tariq

Jajja

Maxwell

et al. 2020

HPB

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Background: Limited literature is available on the postoperative development of impaired glucose tolerance (IGT) and new-onset diabetes mellitus (NODM) following Distal Pancreatectomy (DP). We aimed to study the post-surgical clinical evolution of IGT/DM and its association with preoperative glycemic profiles of patients undergoing DP. Methods: Pre-and postoperative glycemic laboratories were measured in patients undergoing DP by the senior author from 2007-2017. Multivariate risk factor analysis was performed to determine risk factors for new-onset IGT/DM after DP. Kaplan-Meier curves were constructed for development of NODM postoperatively. Results: Of 216 included patients, n = 63, n = 68 and n = 85 were preoperatively diagnosed with nodiabetes (No-DM), pre-diabetes (Pre-DM), and diabetes (DM), respectively. At 2-year follow-up, n = 37, n = 80 and n = 99 were classified as No-DM, Pre-DM or DM, respectively. Pre-diabetics had a higher risk of developing postoperative dysglycemia (RR 2.230, 95% CI 1.732-2.870, p = 0.001). Preoperative OGTT>130, HbA1c >6.0, and chronic pancreatitis were risk factors for postoperative DM.Conclusion: 40% of patients undergoing DP were unaware of their dysglycemic status (pre-DM or DM) pre-operatively. At 2-year follow-up, 36% non-diabetic and 57% pre-diabetic patients had developed NODM. Appropriate pre-operative diabetic assessment is warranted for all patients undergoing pancreatic resections.

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“…In terms of the association between endogenous insulin secretion and the status of diabetes management in type 2 diabetes patients, Iwata et al 7 reported that insulin therapy was required with a specificity of >80% if CPI was <1.0. Although previous studies have identified preoperative glycosylated hemoglobin (HbA1c), body mass index (BMI), age and the procedure of pancreatic resection as risk factors for the development of diabetes after pancreatic resection [8][9][10] , the association between perioperative residual b-cell function evaluated using CPI and the status of diabetes management, including glycemic control and requirement for insulin therapy, after pancreatectomy has not yet been investigated.…”

Section: Introductionmentioning

confidence: 99%

Perioperative C‐peptide index is associated with the status of diabetes management after pancreatectomy

Shikata

Chujo

Enkaku

et al. 2022

J of Diabetes Invest

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Aims/Introduction: This study aimed to identify the clinical factors affecting postoperative residual pancreatic b-cell function, as assessed by the C-peptide index (CPI), and to investigate the association between perioperative CPI and the status of diabetes management after pancreatectomy. Materials and Methods: The associations between perioperative CPI and clinical background, including surgical procedures of pancreatectomy, were analyzed in 47 patients who underwent pancreatectomy, and were assessed for pre-and postoperative CPI. The association between perioperative CPI and glycemic control after pancreatectomy was investigated. Results: The low postoperative CPI group (CPI <0.7) had longer duration of diabetes (17.5 -14.5 vs 5.5 -11.0 years, P = 0.004), a higher percentage of sulfonylurea users (41.7 vs 8.7%, P = 0.003) and a greater number of drug categories used for diabetes treatment (1.9 -1.1 vs 0.8 -0.8, P <0.001) than did the high postoperative CPI group. Postoperative CPI was higher (1.4 -1.2 vs 0.7 -0.6, P = 0.039) in patients with low glycosylated hemoglobin (<7.0%) at 6 months after pancreatectomy; preoperative (2.0 -1.5 vs 0.7 -0.5, P = 0.012) and postoperative CPI (2.5 -1.4 vs 1.4 -1.1, P = 0.020) were higher in non-insulin users than in insulin users at 6 months after surgery. Conclusions: The duration of diabetes and preoperative diabetes treatment were associated with residual pancreatic b-cell function after pancreatectomy. Furthermore, perioperative b-cell function as assessed by CPI was associated with diabetes management status after pancreatectomy.

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Development of Diabetes after Pancreaticoduodenectomy: Results of a 10-Year Series Using Prospective Endocrine Evaluation

Cited by 21 publications

References 39 publications

Ten-year impact of pancreaticoduodenectomy on bowel function and quality of life of patients with ileal pouch-anal anastomosis for familial adenomatous polyposis

Ten-year impact of pancreaticoduodenectomy on bowel function and quality of life of patients with ileal pouch-anal anastomosis for familial adenomatous polyposis

Diabetes development after distal pancreatectomy: results of a 10 year series

Perioperative C‐peptide index is associated with the status of diabetes management after pancreatectomy

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