title: Insulin secretory defect plays a major role in the development of diabetes in patients with distal pancreatectomy.
abstract: To investigate the pathogenesis of distal pancreatectomy (d-Px)-induced diabetes in Korean patients, we investigated insulin secretory and sensitivity indexes obtained by oral glucose tolerance testing in 20 patients that had received d-Px (10 with d-Px-induced diabetes and 10 with normal glucose tolerance with d-Px [NGT d-Px]) and in 164 control subjects (77 with type 2 diabetes mellitus and 87 with NGT) that did not receive d-Px. The pancreatectomized subjects had lower fasting serum insulin, homeostasis model assessment of pancreatic beta-cell function (HOMA-beta) levels, and insulinogenic indices than the NGT controls. The HOMA-beta values of nonobese NGT d-Px- and d-Px-induced diabetic subjects were 73.7% and 38.7% of those for nonobese NGT controls, respectively, and HOMA-beta was significantly lower only for d-Px-induced diabetic subjects (P < .01). In obese subjects, the HOMA-beta values of obese d-Px-induced diabetic subjects were significantly lower than those of obese NGT controls (P < .05). The insulin sensitivity was significantly lower in nonobese type 2 diabetes mellitus controls than in nonobese NGT d-Px or in nonobese d-Px-induced diabetic subjects (P < .001 and .05, respectively). These results show that a reduced insulin secretory function is a typical feature of glucose homeostasis in distal pancreatectomized patients and that insulin secretory defect plays a major role in the development of diabetes in these patients. In addition, the study suggests that pancreatic resections of 60% or less and body mass index are not the main causes of diabetes onset after d-Px in this study.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
authors.forename: Byung-Wan
authors.initials: BW
authors.lastname: Lee
authors.forename: Hahn-Wook
authors.initials: HW
authors.lastname: Kang
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Heo
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sang-Yong
authors.initials: SY
authors.lastname: Kim
authors.forename: Yong-Ki
authors.initials: YK
authors.lastname: Min
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Chung
authors.forename: Moon-Kyu
authors.initials: MK
authors.lastname: Lee
authors.forename: Myung-Shik
authors.initials: MS
authors.lastname: Lee
authors.forename: Kwang-Won
authors.initials: KW
authors.lastname: Kim
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D003920:Diabetes Mellitus / Q000209:etiology* / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D007333:Insulin Resistance / Q000502:physiology; D000078790:Insulin Secretion; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D008055:Lipids