Improvement of glucose metabolism after a pancreatoduodenectomy.
OBJECTIVE
The aim of this study was to investigate the mechanisms of the change in glucose metabolism after a pancreatoduodenectomy (PD).


METHODS
Oral glucose tolerance tests were performed in 17 patients before and 1 month after a PD. The changes in plasma glucose and insulin concentrations, homeostasis model of insulin resistance, and insulinogenic index (beta-cell function) were analyzed. Two additional factors, gastric emptying function and plasma glucagon-like peptide-1 (GLP-1) concentration, that possibly affect perioperative glucose metabolism were also assessed.


RESULTS
The plasma glucose and insulin concentrations were significantly lower after the operation, especially in preoperative diabetic patients. beta-Cell function did not change after the operation. On the other hand, insulin resistance became normal 1 month after the operation. The value of gastric emptying function after the operation was not statistically different in comparison with that before the operation. Postoperative plasma GLP-1 concentration was significantly higher than the preoperative value.


CONCLUSIONS
beta-Cell function is maintained after a PD, whereas the improvement of insulin resistance may cause a short-term transient improvement of the glucose metabolism after the operation. The significance of increased postoperative GLP-1 concentration remains an unsolved issue.
Ohtsuka
Takao
T
Department of Surgery, Saga University Faculty of Medicine, Saga, Japan. takao4412@hotmail.com
Kitahara
Kenji
K
Kohya
Naohiko
N
Miyoshi
Atsushi
A
Miyazaki
Kohji
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications / Q000378:metabolism; D004379:Duodenal Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D005260:Female; D005746:Gastric Emptying; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011446:Prospective Studies
D001786:Blood Glucose; D007328:Insulin; D052216:Glucagon-Like Peptide 1; D005947:Glucose