title: How severe is diabetes after total pancreatectomy? A case-matched analysis.
abstract: OBJECTIVE
  Total pancreatectomy (TP) is associated with significant morbidity and mortality. The severity of postoperative diabetes and existence of 'brittle diabetes' are unclear. This study sought to identify quality of life (QoL) and diabetes-specific outcomes after TP.
  
  
  METHODS
  Patients who underwent TP were matched for age, sex and duration of diabetes with patients with type 1 diabetes. General QoL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) core quality of life questionnaire QLQ-C30 and the PAN26 tool. Diabetes-specific outcomes were assessed using the Problem Areas in Diabetes (PAID) tool and an assessment of diabetes-specific complications and outcomes.
  
  
  RESULTS
  A total of 123 patients underwent TP; 88 died (none of diabetic complications) and two were lost to follow-up. Of the remaining 33 patients, 28 returned questionnaires. Fourteen general and pancreas-specific QoL measurements were all significantly worse amongst the TP cohort (QLQ-C30 + PAN26). However, when diabetes-specific outcomes were compared using the PAID tool, only one of 20 was significantly worse. HbA1c values were comparable (P = 0.299), as were diabetes-related complications such as hypoglycaemic attacks and organ dysfunction.
  
  
  CONCLUSIONS
  Total pancreatectomy is associated with impaired QoL on general measures compared with that in type 1 diabetes patients. Importantly, however, there was almost no significant difference in diabetes-specific outcomes as assessed by a diabetes-specific questionnaire, or in diabetes control. This study does not support the existence of 'brittle diabetes' after TP.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Birmingham National Health Service (NHS) Trust, Birmingham, UK.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: Georgina
authors.initials: G
authors.lastname: Blanco
authors.forename: Jonathan
authors.initials: J
authors.lastname: Webber
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human