title: Glycemic Predictors of Insulin Independence After Total Pancreatectomy With Islet Autotransplantation.
abstract: BACKGROUND
  Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in some patients. Predictors of insulin independence are needed for appropriate patient selection and counseling.
  
  
  OBJECTIVE
  To explore glycemic predictors of insulin independence after TPIAT.
  
  
  METHODS
  A prospective cohort of patients.
  
  
  METHODS
  We investigated 34 patients undergoing TPIAT from 2011-2016 at Johns Hopkins Hospital, all had a 75-g oral glucose tolerance test (OGTT) administered prior to their TPIAT. The primary outcome was insulin independence 1 year after TPIAT.
  
  
  RESULTS
  Ten of 34 (29%) patients were insulin independent 1 year after TPIAT. All patients with impaired fasting glucose and/or impaired glucose tolerance preoperatively were insulin dependent at 1 year. In age-adjusted regression analyses, fasting glucose ≤ 90 mg/dL [odds ratio (OR) = 6.56; 1.11 to 38.91; P = 0.04], 1-hour OGTT glucose ≤ 143 mg/dL (OR = 6.65; 1.11 to 39.91; P = 0.04), and 2-hour OGTT glucose ≤ 106 mg/dL (OR = 11.74; 1.46 to 94.14; P = 0.02) were significant predictors of insulin independence. In receiver operating characteristic analyses, homeostatic model assessment of β-cell function (HOMA-β) was the most robust predictor of insulin independence [area under the curve (AUC) = 0.88; 0.73 to 1.00].
  
  
  CONCLUSIONS
  Normal preoperative glucose status and lower fasting and postchallenge OGTT glucose values are significant predictors of insulin independence after TPIAT. Higher islet function (HOMA-β) was the strongest predictor. OGTT testing may be a useful tool to aid in patient counseling prior to TPIAT and should be further investigated.
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism.
authors.forename: Michael
authors.initials: M
authors.lastname: Quartuccio
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism.
authors.forename: Erica
authors.initials: E
authors.lastname: Hall
authors.affiliation: Division of Gastroenterology and Hepatology.
authors.forename: Vikesh
authors.initials: V
authors.lastname: Singh
authors.affiliation: Division of Surgical Oncology, and.|Division of Transplant Surgery, Johns Hopkins University, Baltimore, Maryland 21287.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Division of Surgical Oncology, and.|Division of Transplant Surgery, Johns Hopkins University, Baltimore, Maryland 21287.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Division of Transplant Surgery, Johns Hopkins University, Baltimore, Maryland 21287.
authors.forename: Niraj
authors.initials: N
authors.lastname: Desai
authors.affiliation: Division of Surgical Oncology, and.
authors.forename: Christi
authors.initials: C
authors.lastname: Walsh
authors.affiliation: Division of Transplant Surgery, Johns Hopkins University, Baltimore, Maryland 21287.
authors.forename: Daniel
authors.initials: D
authors.lastname: Warren
authors.affiliation: Division of Transplant Surgery, Johns Hopkins University, Baltimore, Maryland 21287.
authors.forename: Zhaoli
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Division of Gastroenterology and Hepatology.
authors.forename: Ellen
authors.initials: E
authors.lastname: Stein
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism.
authors.forename: Rita R
authors.initials: RR
authors.lastname: Kalyani
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology / Q000209:etiology; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D011236:Prediabetic State / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin