Diabetes mellitus and pre-diabetes are frequently undiagnosed and underreported in patients referred for pancreatic surgery. A prospective observational study

Roeyen, Geert; Jansen, M.; Chapelle, T.; Bracke, B.; Hartman, V.; Ysebaert, Dirk; Block, Christophe De

doi:10.1016/j.pan.2016.04.032

Cited by 19 publications

(20 citation statements)

References 30 publications

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“…A total of 51 articles were utilized for the review, with 14 addressing malnutrition and pancreatic dysfunction at pancreatic cancer diagnosis [13,14,15,16,17,18,19,20,21,22,23,24,25,26]; 19 addressing pancreatic dysfunction after surgery [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], including 10 which also discussed preoperative dysfunction and nutrition [27,30,31,32,33,35,37,39,40,41]; and 18 addressing nutritional intervention [11,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62] (Figure 1). …”

Section: Resultsmentioning

confidence: 99%

“…DM occurs more frequently in patients with pancreatic cancer than in the general population [15]. Approximately 50% of patients are diabetic or insulin deficient at the time of cancer diagnosis; of these, half are diagnosed within three years of diabetes diagnosis [14,17,19,66].…”

Section: Discussionmentioning

confidence: 99%

“…Those who were diagnosed with DM follow other conventional risk factors, including a higher BMI and family history of DM [19,26]. Roeyen et al and Pannala et al showed higher incidences of NODM, at about 75%, in the two years prior to pancreatic cancer diagnosis [15,19]. However, these results did not capture all NODM, since approximately 34% were identified as undiagnosed DM in the study by Roeyen et al [15].…”

Section: Discussionmentioning

confidence: 99%

“…Roeyen et al and Pannala et al showed higher incidences of NODM, at about 75%, in the two years prior to pancreatic cancer diagnosis [15,19]. However, these results did not capture all NODM, since approximately 34% were identified as undiagnosed DM in the study by Roeyen et al [15]. Furthermore, 35% of patients had decreased endocrine function through impaired fasting glucose or glucose intolerance [15].…”

Section: Discussionmentioning

confidence: 99%

“…However, these results did not capture all NODM, since approximately 34% were identified as undiagnosed DM in the study by Roeyen et al [15]. Furthermore, 35% of patients had decreased endocrine function through impaired fasting glucose or glucose intolerance [15]. …”

Section: Discussionmentioning

confidence: 99%

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Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

et al. 2017

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Pancreatic cancer is an aggressive malignancy with a poor prognosis. The disease and its treatment can cause significant nutritional impairments that often adversely impact patient quality of life (QOL). The pancreas has both exocrine and endocrine functions and, in the setting of cancer, both systems may be affected. Pancreatic exocrine insufficiency (PEI) manifests as weight loss and steatorrhea, while endocrine insufficiency may result in diabetes mellitus. Surgical resection, a central component of pancreatic cancer treatment, may induce or exacerbate these dysfunctions. Nutritional and metabolic dysfunctions in patients with pancreatic cancer lack characterization, and few guidelines exist for nutritional support in patients after surgical resection. We reviewed publications from the past two decades (1995–2016) addressing the nutritional and metabolic status of patients with pancreatic cancer, grouping them into status at the time of diagnosis, status at the time of resection, and status of nutritional support throughout the diagnosis and treatment of pancreatic cancer. Here, we summarize the results of these investigations and evaluate the effectiveness of various types of nutritional support in patients after pancreatectomy for pancreatic adenocarcinoma (PDAC). We outline the following conservative perioperative strategies to optimize patient outcomes and guide the care of these patients: (1) patients with albumin < 2.5 mg/dL or weight loss > 10% should postpone surgery and begin aggressive nutrition supplementation; (2) patients with albumin < 3 mg/dL or weight loss between 5% and 10% should have nutrition supplementation prior to surgery; (3) enteral nutrition (EN) should be preferred as a nutritional intervention over total parenteral nutrition (TPN) postoperatively; and, (4) a multidisciplinary approach should be used to allow for early detection of symptoms of endocrine and exocrine pancreatic insufficiency alongside implementation of appropriate treatment to improve the patient’s quality of life.

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