title: Diabetes mellitus and pre-diabetes are frequently undiagnosed and underreported in patients referred for pancreatic surgery. A prospective observational study.
abstract: OBJECTIVE
  Previous reports on the prevalence of diabetes in pancreatic cancer and chronic pancreatitis patients are based on inconsistent and equivocal criteria. The objective of this study is to prospectively assess with conclusive methods the preoperative glycaemic status of patients undergoing pancreatic surgery. We hypothesise that most of those patients are unaware of these disturbances in glycaemic status and that the prevalence is underestimated.
  
  
  METHODS
  During the last 2 years, patients referred for pancreatic surgery and without history of diabetes underwent a prospective preoperative screening with an oral glucose tolerance test (OGTT) and determination of the glycated haemoglobin level (HbA1c). The American Diabetes Association's criteria for diabetes and pre-diabetes were used. Beta-cell function and insulin sensitivity were calculated using HOMA2 indices. Impact on surgical policy has been scored.
  
  
  RESULTS
  99 patients were screened, 25 had a history of diabetes. The other 74 underwent an OGTT and HbA1c determination. Only 29.7% (22/74) had a normal glucose metabolism, while 8.1% (6/74) had impaired fasting glucose, 21.6% (16/74) had impaired glucose tolerance, 6.7% (5/74) had a combination of both, and 33.8% (25/74) had undiagnosed diabetes. In 15.2% (15/99) of the patients, this preoperative assessment had an impact on surgical policy.
  
  
  CONCLUSIONS
  77.7% of patients referred for pancreatic surgery had some degree of (pre-)diabetes. In 70.3% of patients without a history of diabetes, these disturbances in glucose metabolism are a new finding. Physicians involved in pancreatic surgery should be aware of the frequently undiagnosed (pre-)diabetes and actively check for it. This prevalence is underestimated.
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium. Electronic address: geert.roeyen@uza.be.
authors.forename: Geert
authors.initials: G
authors.lastname: Roeyen
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
authors.forename: Miet
authors.initials: M
authors.lastname: Jansen
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
authors.forename: Thiery
authors.initials: T
authors.lastname: Chapelle
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Bracke
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
authors.forename: Vera
authors.initials: V
authors.lastname: Hartman
authors.affiliation: Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ysebaert
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: De Block
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000601:surgery*; D010186:Pancreatic Function Tests; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000601:surgery; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Adenocarcinoma; Chronic pancreatitis; Endocrine function; Pancreas; Pancreatogenic diabetes; Prediabetes