title: Immediate post-resection diabetes mellitus after pancreaticoduodenectomy: incidence and risk factors.
abstract: BACKGROUND
  New-onset diabetes mellitus after a pancreaticoduodenectomy (PD) remains poorly defined. The aim of this study was to define the incidence and predictive factors of immediate post-resection diabetes mellitus (iPRDM).
  
  
  METHODS
  Retrospective review of patients undergoing PD from January 2004 through to July 2010. Immediate post-resection diabetes mellitus was defined as diabetes requiring pharmacological treatment within 30 days post-operatively. Logistic regression was conducted to identify factors predictive of iPRDM.
  
  
  RESULTS
  Of 778 patients undergoing PD, 214 were excluded owing to pre-operative diabetes (n= 192), declined research authorization (n= 14) or death prior to hospital discharge (n= 8); the remaining 564 patients comprised the study population. iPRDM occurred in 22 patients (4%) who were more likely to be male, have pre-operative glucose intolerance, or an increased creatinine, body mass index (BMI), pre-operative glucose, operative time, tumour size or specimen length compared with patients without iPRDM (P < 0.05). On multivariate analysis, pre-operative impaired glucose intolerance (P < 0.001), pre-operative glucose ≥ 126 (P < 0.001) and specimen length (P= 0.002) were independent predictors of iPRDM. A predictive model using these three factors demonstrated a c-index of 0.842.
  
  
  CONCLUSIONS
  New-onset, post-resection diabetes occurs in 4% of patients undergoing PD. Factors predictive of iPRDM include pre-operative glucose intolerance, elevated pre-operative glucose and increased specimen length. These data are important for patient education and predicting outcomes after PD.
authors: Department of Surgery, Mayo Clinic Rochester, Rochester, MI, USA.
authors: Michael J
authors: MJ
authors: Ferrara
authors: Christine
authors: C
authors: Lohse
authors: Yogish C
authors: YC
authors: Kudva
authors: Michael B
authors: MB
authors: Farnell
authors: Florencia G
authors: FG
authors: Que
authors: Kaye M
authors: KM
authors: Reid-Lombardo
authors: John H
authors: JH
authors: Donohue
authors: David M
authors: DM
authors: Nagorney
authors: Suresh T
authors: ST
authors: Chari
authors: Santhi S
authors: SS
authors: Vege
authors: Michael L
authors: ML
authors: Kendrick
mesh_terms: D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents
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