Detailed Abstract
[BP Poster Presentation 4]
[BP PP 4-2] Assessment of glucose metabolism alterations after partial pancreatectomy using biochemical markers: A prospective observational study
Jun Suh LEE, Yoo-Seok YOON*, Junyub KIM, Boram LEE, YoungRok CHOI, Jai Young CHO, Ho-Seong HAN
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Seoul National University Bundang Hospital, Korea
Introduction : Most previous studies on glucose metabolism after pancreatectomy used review of medical records as diagnostic criteria of DM. This study aimed to evaluate the incidence and characteristics of new-onset DM (NODM) and worsened preexisting DM after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) using serial assessment of biochemical markers in a prospective cohort.
Methods : Data was prospectively collected for 224 patients who received PD (n=149) and DP (n=75) between 2015 and 2018. Diabetes related parameters were assessed preoperatively and postoperatively (at 3 months and 1 year): oral glucose tolerance test, HbA1c, fasting insulin, and stimulated insulin. Homeostasis model assessment (HOMA) was calculated for IR (insulin resistance) and B (beta cell function).
Results : The incidence of NODM (14% vs. 45%, P=0.001) and worsened DM (21% vs. 60%, P<0.001) was significantly higher after DP than PD at postoperative 1 year. There was more DM resolution after PD. (41% vs. 9%, P=<0.001) BMI and type of surgery (DP) were risk factors of NODM, while only type of surgery (DP) was a risk factor of worsened DM. In DP patients without preoperative DM, those who developed NODM had a significantly lower preoperative HOMA-B level compared to those who did not. (P=0.035) PD patients who developed NODM showed a sustained decrease in HOMA-B postoperatively, whereas those who did not showed a plateau, after an initial decrease.
Conclusions : DP had higher risk of NODM development and DM worsening that PD. Patient education and surveillance for the development of DM after pancreatectomy should be tailored according to type of resection.
Methods : Data was prospectively collected for 224 patients who received PD (n=149) and DP (n=75) between 2015 and 2018. Diabetes related parameters were assessed preoperatively and postoperatively (at 3 months and 1 year): oral glucose tolerance test, HbA1c, fasting insulin, and stimulated insulin. Homeostasis model assessment (HOMA) was calculated for IR (insulin resistance) and B (beta cell function).
Results : The incidence of NODM (14% vs. 45%, P=0.001) and worsened DM (21% vs. 60%, P<0.001) was significantly higher after DP than PD at postoperative 1 year. There was more DM resolution after PD. (41% vs. 9%, P=<0.001) BMI and type of surgery (DP) were risk factors of NODM, while only type of surgery (DP) was a risk factor of worsened DM. In DP patients without preoperative DM, those who developed NODM had a significantly lower preoperative HOMA-B level compared to those who did not. (P=0.035) PD patients who developed NODM showed a sustained decrease in HOMA-B postoperatively, whereas those who did not showed a plateau, after an initial decrease.
Conclusions : DP had higher risk of NODM development and DM worsening that PD. Patient education and surveillance for the development of DM after pancreatectomy should be tailored according to type of resection.
SESSION
BP Poster Presentation 4
E-Session 7/27 ~ 7/29 ALL DAY