title: Blood Glucose Homeostasis in the Course of Partial Pancreatectomy--Evidence for Surgically Reversible Diabetes Induced by Cholestasis.
abstract: OBJECTIVE
  Partial pancreatic resection is accompanied not only by a reduction in the islet cell mass but also by a variety of other factors that are likely to interfere with glucose metabolism. The aim of this work was to characterize the patient dynamics of blood glucose homeostasis during the course of partial pancreatic resection and to specify the associated clinico-pathological variables.
  
  
  METHODS
  In total, 84 individuals undergoing elective partial pancreatic resection were consecutively recruited into this observational trial. The individuals were assigned based on their fasting glucose or oral glucose tolerance testing results into one of the following groups: (I) deteriorated, (II) stable or (III) improved glucose homeostasis three months after surgery. Co-variables associated with blood glucose dynamics were identified.
  
  
  RESULTS
  Of the 84 participants, 25 (30%) displayed a normal oGTT, 17 (20%) showed impaired glucose tolerance, and 10 (12%) exhibited pathological glucose tolerance. Elevated fasting glucose was present in 32 (38%) individuals before partial pancreatic resection. Three months after partial pancreatic resection, 14 (17%) patients deteriorated, 16 (19%) improved, and 54 (64%) retained stable glucose homeostasis. Stability and improvement was associated with tumor resection and postoperative normalization of recently diagnosed glucose dysregulation, preoperatively elevated tumor markers and markers for common bile duct obstruction, acute pancreatitis and liver cell damage. Improvement was linked to preoperatively elevated insulin resistance, which normalized after resection and was accompanied by a decrease in fasting- and glucose-stimulated insulin secretion.
  
  
  CONCLUSIONS
  Surgically reversible blood glucose dysregulation diagnosed concomitantly with a (peri-) pancreatic tumor appears secondary to compromised liver function due to tumor compression of the common bile duct and the subsequent increase in insulin resistance. It can be categorized as "cholestasis-induced diabetes" and thereby distinguished from other forms of hyperglycemic disorders.
authors.affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ehehalt
authors.affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Sturm
authors.affiliation: Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
authors.forename: Manuela
authors.initials: M
authors.lastname: Rösler
authors.affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kersting
authors.affiliation: Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany; Department of Medicine III, University Hospital Carl Gustav Carus, TU Dresden, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ludwig
authors.affiliation: Coordination Center for Clinical Trials, TU Dresden, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Schwanebeck
authors.affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
authors.forename: Hans-Detlev
authors.initials: HD
authors.lastname: Saeger
authors.affiliation: Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany; Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany.
authors.forename: Michele
authors.initials: M
authors.lastname: Solimena
authors.affiliation: Department of GI, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Grützmann
mesh_terms: D000328:Adult; D000368:Aged; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002779:Cholestasis / Q000150:complications / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000378:metabolism / Q000473:pathology / Q000601:surgery*
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D001786:Blood Glucose; D005947:Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; C578959:carbohydrate antigen 199, human; C517652:hemoglobin A1c protein, human