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J Surg Res. 2018 Jul;227:211-219. doi: 10.1016/j.jss.2018.02.010. Epub 2018 Mar 20.

Diabetes after pancreaticoduodenectomy: can we predict it?

Author information

1
Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India. Electronic address: anandnsingh@gmail.com.
2
Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.
3
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
4
Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India.

Abstract

BACKGROUND:

There is limited literature about the perioperative factors which can predict endocrine insufficiency after pancreaticoduodenectomy (PD). The primary aim was to correlate percentage pancreatic remnant volume (%RV) after PD in nondiabetic patients with the development of new-onset impaired glucose tolerance/diabetes mellitus (IGT/DM). The secondary aim was to identify the risk factors for new-onset IGT/DM.

METHODS:

In this prospective study, all consecutive patients with resectable periampullary carcinoma and without IGT/DM were evaluated with fasting and postprandial plasma glucose, HbA1c, insulin, and C-peptide levels preoperatively and at 3 mo postoperatively. After that, all patients were followed up with fasting and postprandial plasma glucose level assessed at 3-mo intervals for 24 mo or till death, whichever occurred earlier. The %RV was determined from computed tomography measurements preoperatively.

RESULTS:

Of the 50 patients, 11 (22%) patients developed IGT/DM after median follow-up of 32 mo. The patients' with/without IGT/DM were similar in demographic/perioperative variables. The %RV was found to be an independent factor associated with new-onset IGT/DM. A %RV of <48.8% was found to be a predictor of new-onset IGT/DM (sensitivity, 89.7%; specificity, 73.6%). Plasma sugar and glycosylated hemoglobin levels were significantly higher postoperatively after PD than the preoperative levels. Insulin and C-peptide levels were significantly lower after PD, irrespective of new-onset IGT/DM.

CONCLUSIONS:

The incidence of IGT/DM after PD was 22%, and %RV < 48.8% was found to be a significant risk factor for new-onset IGT/DM. (CTRI/2013/12/004233).

KEYWORDS:

Diabetes; Endocrine insufficiency; Pancreatic resection; Pancreatic volume; Pancreaticoduodenectomy; Pancreatoduodenectomy; Type III diabetes

PMID:
29804855
DOI:
10.1016/j.jss.2018.02.010

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