Improved glucose metabolism after subtotal pancreatectomy for pancreatic cancer

Abstract

Diabetes occurs frequently in patients with pancreatic cancer. To investigate the impact to tumour removal, seven patients were studied before and after 85 per cent subtotal pancreatectomy for adenocarcinoma of the pancreas. The frequency of diabetes was determined by the oral glucose tolerance test. Fasting levels of C peptide and insulin were measured in plasma, and insulin secretion was investigated by hyperglycaemic glucose clamp and glucagon stimulation. Six of the seven patients were diabetic before surgery and four required insulin treatment. Improvements in diabetic status and glucose metabolism were found in all seven patients after operation, as demonstrated by increased glucose metabolic capacity during hyperglycaemia. This occurred despite a postoperative reduction in insulin secretion and is explained by the observed augmentation of whole-body insulin sensitivity after surgery. A diabetogenic factor may be produced by pancreatic adenocarcinoma that may be responsible, directly or indirectly, for the high frequency of diabetes in patients with pancreatic cancer.

Metabolic consequences of a 50% partial pancreatectomy in humans

“…This finding has been attributed to an improvement in insulin sensitivity after removal of the pancreatic tumour [36]. The present data are partly consistent with these studies as they show improvement in glucose tolerance following the partial pancreatectomy.…”

“…Significant improvements in glucose tolerance following partial pancreatectomy have previously been reported in patients with pancreatic cancer [15,36]. This finding has been attributed to an improvement in insulin sensitivity after removal of the pancreatic tumour [36].…”

Probability of Pancreatic Cancer Following Diabetes: A Population-Based Study

“…In humans, resection of pancreatic cancer leads to amelioration or remission of diabetes. 21 The report by Basso et al 45 that a peptide with m/z 2030 may be a putative diabetogenic factor in pancreatic cancer suggests that a serologic marker of diabetes induced by pancreatic cancer may be identified in the near future.…”

Diabetes status and post-load plasma glucose concentration in relation to site-specific cancer mortality: findings from the original Whitehall study

“…The finding in several studies 11-13;41 of an elevated risk of this malignancy in diabetic groups has been attributed to reverse causality, 42 such that existing but clinically undetected carcinoma at study induction leads to elevated blood glucose levels. That a high proportion of pancreatic cancer patients reportedly present with diabetes or IGT, 16;43 and partial pancreatectomy in a small group of cancer patients had a normalising effect on blood glucose levels, 44 provides some support for this assertion. To examine the role of reverse causality in the diabetes-pancreatic cancer relation, we excluded those deaths occurring in the first 10 years of mortality surveillance ( In comparison with the evidence base for pancreatic cancer, reports of the relationship between diabetes and liver cancer are more sparse.…”