title: Incidence and severity of pancreatogenic diabetes after pancreatic resection.
abstract: BACKGROUND
  While many patients experience prolonged survival after pancreatic resection for benign or malignant disease, the long-term risk of pancreatogenic diabetes mellitus (DM) remains poorly characterized.
  
  
  METHODS
  One thousand one hundred seven patients underwent pancreatectomy at Thomas Jefferson University between 2006 and 2013. Attempts were made to contact all living patients by telephone and a DM-focused questionnaire was administered.
  
  
  RESULTS
  Two hundred fifty-nine of 691 (37 %) surviving patients completed the survey, including 179 pancreaticoduodenectomies (PD), 78 distal pancreatectomies (DP), and 2 total pancreatectomies. In the PD group, 44 (25 %) patients reported having DM prior to resection. Of these, 5 (12 %) had improved glucose control after resection and 21 (48 %) reported escalated DM medication requirements post-resection. Of 135 PD patients without preoperative DM, 24 (18 %) had new-onset DM postoperatively. In the DP group, 23 patients (29 %) had DM preoperatively. None had improved glucose control after resection, while six (26 %) had worse control after resection. Seventeen of 55 DP patients (31 %) without preoperative DM developed new-onset DM postoperatively (p = 0.04 vs. PD). Preoperative HgbA1C >6.0 %, glucose >124 mg/dL, and insulin use >2 units per day were associated with an increased risk of new-onset postoperative DM.
  
  
  CONCLUSIONS
  The development or worsening of DM after pancreatic resection is extremely common, with different types of resections conveying different risks for disease progression. DP places patients at a greater risk for the development of new-onset postoperative diabetes when compared to PD. In contrast, patients with preoperative diabetes are more likely to experience worsening of their disease after PD as compared to DP. Patients should be screened prospectively, particularly those at highest risk, and informed of and educated about the potential for post-resection DM.
authors.affiliation: Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Burkhart
authors.forename: Susan M
authors.initials: SM
authors.lastname: Gerber
authors.forename: Renee M
authors.initials: RM
authors.lastname: Tholey
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Lamb
authors.forename: Anitha
authors.initials: A
authors.lastname: Somasundaram
authors.forename: Caitlin A
authors.initials: CA
authors.lastname: McIntyre
authors.forename: Eliza C
authors.initials: EC
authors.lastname: Fradkin
authors.forename: Annie P
authors.initials: AP
authors.lastname: Ashok
authors.forename: Robert F
authors.initials: RF
authors.lastname: Felte
authors.forename: Jaya M
authors.initials: JM
authors.lastname: Mehta
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Harish
authors.initials: H
authors.lastname: Lavu
authors.forename: Serge A
authors.initials: SA
authors.lastname: Jabbour
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Winter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010182:Pancreatic Diseases / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011184:Postoperative Period; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human