Long- term glycemic control after pancreatectomy- prospective study

Abstract

INTRODUCTION: Pancreatic resection leads to loss of functional pancreatic tissue. The study evaluates the glycemic control and factors affecting the glycemic control in long-term survivors after pancreatic resection. MATERIAL AND METHODS: Patients who survived for three months or more after pancreatectomy were selected. Baseline parameters were collected with an interviewer administered questionnaire. All patients had a fasting blood sugar (FBS) and HbA1C. Previous non diabetics had oral glucose tolerance test (OGTT) at one and two hours. There were 49 Whipple procedures and 6 distal pancreatectomies. 20 Whipple procedure patients and 5 distal pancreatectomy patients consented. Sixteen (64%) participants were females. Median age was 47 (15-70) years. Eleven (44%) were previously known diabetic patients. The median Body Mass Index (BMI) was 18.28 kg/m3 (11.36-30.07). The median time since surgery was 16 (3-37) months. There was one (4%) newly diagnosed diabetic patient. Out of non-diabetics, one had more than 200 mg/dl OGTT at 2 hours. Nine diabetics had HbA1c elevation more than 7%. Mean post-surgical FBS in diabetic patients (136.9 mg/dl) were significantly (p<0.05) higher than pre-surgical FBS (109.4 mg/dl). BMI (p=0.006), waist to hip ratio (p=0.039) and percentage of pancreas removed (p=0.002) showed a significant correlation to worsening of post-surgical sugar control. CONCLUSIONS: Pancreatectomy leads to worsening of blood sugar control in known diabetics. New onset diabetes is rare. Close follow-up and strict control is needed in known diabetics with high BMI and high waist to hip ratio.