Glucose Metabolism After Pancreatectomy: Opposite Extremes Between Pancreaticoduodenectomy and Distal Pancreatectomy

Abstract

Context The rate of glucose metabolism changes drastically after partial pancreatectomy. Objectives To analyze the changes in patients’ glucose metabolism and endocrine and exocrine function before and after partial pancreatectomy relative to different resection types (Kindai Prospective Study on Metabolism and Endocrinology after Pancreatectomy: KIP-MEP study). Methods A series of 278 consecutive patients with scheduled pancreatectomy were enrolled into our prospective study. Of them, 109 individuals without diabetes, who underwent partial pancreatectomy, were investigated. Data were compared between patients with pancreaticoduodenectomy (PD, n = 73) and those with distal pancreatectomy (DP, n = 36). Results Blood glucose levels during the 75gOGTT (75-g oral glucose tolerance test) significantly decreased after pancreatectomy in the PD group (area under the curve (AUC) -9.3%, P < 0.01), and significantly increased in the DP population (AUC +16.8%, P < 0.01). Insulin secretion rate during 75gOGTT and glucagon stimulation test significantly decreased after pancreatectomy in both the PD and DP groups (P < 0.001). Both groups showed similar HOMA-IR (homeostasis model assessment of insulin resistance) values after pancreatectomy. Decrease in the exocrine function quality after pancreatectomy was more marked in association with PD than DP (P < 0.01). Multiple regression analysis indicated that resection type and preoperative HOMA-IR independently influenced glucose tolerance-related postoperative outcomes. Conclusions Blood glucose levels after the OGTT markedly differed between PD and DP populations. The observed differences between PD and DP suggest the importance of individualization in the management of metabolism and nutrition after partial pancreatectomy.

Three-Year Observation of Glucose Metabolism After Pancreaticoduodenectomy: A Single-Center Prospective Study in Japan

“…That is, there are more pancreatic beta cells in the pancreatic tail than there are in the pancreatic head ( 35 ), suggesting that the degree of decrease in pancreatic beta cells is greater in DP than in PD. Another possibility, as we have reported, could be different digestion and absorption patterns of glucose due to different methods of gastrointestinal reconstruction ( 13 ). For these reasons, it is necessary to investigate risk factors for diabetes independently of PD and DP, rather than lumping them together as partial pancreatectomy.…”

“…From June 2015 to May 2021, 457 patients scheduled to undergo pancreatectomy at the Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kindai University Hospital were enrolled in the Ki ndai P rospective Study on M etabolism and E ndocrinology after P ancreatectomy (KIP-MEP study) ( 13 ). The KIP-MEP study recruited participants who met the following criteria: scheduled to undergo pancreatectomy, aged > 20 years, provided consent to participate.…”

“…We previously reported on the difference in the changes to glucose tolerance 1 month after surgery between PD and DP. PD resulted in an improvement in the blood glucose level in many patients, whereas DP resulted in a deterioration ( 13 ). However, since some patients still experience worsening blood glucose levels even after PD, it is necessary to investigate the differences between these patients and those with improvement.…”

β‐Cell failure in diabetes: Common susceptibility and mechanisms shared between type 1 and type 2 diabetes

“…In partial pancreatectomy, approximately half of the pancreas is typically resected, leading to a marked reduction in β‐cell mass, and increase in insulin demand and stress against the remaining β‐cells. In our prospective studies on β‐cell function and glucose tolerance after pancreatectomy 101 , even though the same volume and portion of the pancreas were resected, we noticed considerable interindividual variation in glucose tolerance and in whether diabetes eventually developed. Similar observations have been reported in diabetes development after hemi‐pancreatectomy in living donors of pancreas transplantation 102,103 .…”

Imbalance hepatic metabolism homeostasis in the F1 generation of endometrial DNMT3B conditional knockout female mice

“…Similarly, Rajesh et al found that gestational exposure to DEHP caused pancreatic β-cell dysfunction and whole body glucometabolic abnormalities in the F1 offspring due to the down regulation in the expression of critical genes (Rajesh and Balasubramanian, 2015). Niwano et al suggested that blood glucose levels showed significant change during oral GTT following partial pancreatectomy of different resection types in patients (Niwano et al, 2021), indicating the importance of pancreas in blood glucose regulation. Moreover, Frontiers in Physiology frontiersin.org other glucose transporters such as GLUT 3 and GLUT 4 are located in neurons, intestine, testicles, kidneys, muscles, and adipose tissues (Tirone and Brunicardi, 2001).…”