title: Metabolic effect of pancreatoduodenectomy: Resolution of diabetes mellitus after surgery.
abstract: BACKGROUND
  It is considered natural that glucose tolerance worsens after pancreatectomy. However, diabetes mellitus (DM) resolves after metabolic bypass surgery and anatomic changes after PD resemble those after metabolic surgery. This study assessed the incidence of DM resolution after pancreatectomy and differences in metabolic parameters following pancreatoduodenectomy (PD) and distal pancreatectomy (DP).
  
  
  METHODS
  Between 2007 and 2013, 218 consecutive patients with pancreatic diseases underwent PD (n = 112) or DP (n = 106) at Seoul National University Hospital. Factors associated with changes in glucose homeostasis were evaluated by assaying serum glucose concentrations in prospectively collected samples.
  
  
  RESULTS
  Of the 218 patients, 88 (40.4%) had preoperative DM, with 27 (30.7%) of the latter showing postoperative resolution of DM, a rate significantly higher in patients who had undergone PD than DP (40.4% vs. 12.9%, p = 0.008). Fasting blood glucose (p = 0.001), PP2 (p < 0.001), and HOMA-IR (p = 0.005) significantly decreased after PD but not after DP. Multivariate analysis revealed that PD was independently associated with DM resolution (odds ratio 7.790, p = 0.003). PD was associated with a significantly higher DM resolution rate than DP among the 37 pancreatic cancer patients with preoperative DM (34.6% vs. 0%, p = 0.036). DM resolution rates were similar in pancreatic cancer and other pancreatic diseases (p = 0.419).
  
  
  CONCLUSIONS
  More than 40% of patients with preoperative DM show resolution after PD. Decreased insulin resistance and suspected enhanced glucose stimulated insulin secretion decreasing PP2 seem to contribute improved glucose homeostasis after PD. BMI was unrelated to DM resolution, indicating that PD-associated physio-anatomical changes may help resolve DM independent of weight.
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hye Seung
authors.initials: HS
authors.lastname: Jung
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Woohyun
authors.initials: W
authors.lastname: Jung
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Shin
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: sunkim@snu.ac.kr.
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy
chemical_list: D001786:Blood Glucose
keywords: Diabetes mellitus; Endocrine insufficiency; Metabolic surgery; Pancreas; Pancreatectomy; Pancreatoduodenectomy