title: Impact of pancreatic cancer and subsequent resection on glycemic control in diabetic and nondiabetic patients.
abstract: The incidence of new onset or worsening diabetes is surprisingly low in patients after partial pancreatectomy for cancer, leading us to question what factors predict diminished glycemic control in those undergoing resection. All patients undergoing pancreatectomy for cancer at a large,  rural university teaching hospital between 1996 and 2010 were identified. The incidence of new onset, or worsening, existing diabetes was determined based on pre and postoperative medication requirement. Univariate analysis was undertaken to identify factors that predict worsened glycemic  control. One hundred and one (1 total, 79 Whipple, 21 distal) patients were identified, 41 per cent of which had preexisting diabetes. Nearly half of existing diabetics manifested an increased medication requirement prior to their cancer diagnosis. New onset diabetes occurred in 20 per cent  of postoperative patients. Of established diabetics, 34 per cent had either improved glycemic control (9/41) or were cured (5/41) despite the reduction of islet cell mass that occurred with surgery. On univariate analysis, only prolonged hospitalization was associated with worsened glycemic  control. Diminished glycemic control is a frequent presenting symptom of pancreatic cancer. Worsened or new onset diabetes is associated with length of stay, which can be influenced by a number of factors including complications and comorbidities.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, North Carolina, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Steven C
authors.initials: SC
authors.lastname: Agle
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Fuhr
authors.forename: James H
authors.initials: JH
authors.lastname: Mehaffey
authors.forename: Brett H
authors.initials: BH
authors.lastname: Waibel
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents