Changes in the body composition and nutritional status after total pancreatectomy

Uemura, Masao; Ohgi, Katsuhisa; Sugiura, Teiichi; Okamura, Yukiyasu; Ito, Takaaki; Yamamoto, Yusuke; Ashida, Ryo; Aramaki, Takeshi; Notsu, Akifumi; Kawabata, Takanori; Uesaka, Katsuhiko

doi:10.1007/s00423-021-02185-x

Cited by 3 publications

(2 citation statements)

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“…During the long-term follow-up, we noted the mean HbA 1c level of 7.43% after TP was in accordance with recent larger cohorts, which ranged from 7.3% to 7.9% ( 10 , 19 – 23 ). Several previous studies reported the incidence of hypoglycemia after TP ranging from 42.0% to 100.0% with a median of 2 occurrences per week or 10 per month ( 10 , 24 – 28 ), and body weight loss, low total cholesterol level, strict glycemic control, and using rapid-acting insulin were risk factors for hypoglycemia ( 28 ).…”

Section: Discussionsupporting

confidence: 91%

“…With the recovery of food intake and sufficient pancreatin replacement, the mean daily insulin dose at long-term follow-up considerably increased compared to one month after surgery. The mean daily insulin dose was 27.09 ± 11.88 units/day (0.49 ± 0.19 units/kg/day), which was in parallel with that in other published studies varying from 23 to 37 units ( 8 , 10 , 23 – 25 , 34 , 35 ) or 0.50 to 0.58 units/kg/day ( 15 , 21 , 23 , 34 ). Our findings, which were also in line with the previous research, showed a marked decrease in daily insulin requirements and basal insulin percentages in patients after TP compared to T1DM with similar BMI and complete insulin deficiency ( 36 , 37 ).…”

Section: Discussionsupporting

confidence: 86%

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Diabetes management in patients undergoing total pancreatectomy: A single center cohort study

et al. 2023

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BackgroundTotal pancreatectomy (TP) has been increasingly performed in recent years. However, studies on diabetes management after TP during different postoperative periods are still limited.ObjectivesThis study aimed to evaluate the glycemic control and insulin therapy of patients undergoing TP during the perioperative and long-term follow-up period.MethodsNinety-three patients undergoing TP for diffuse pancreatic tumors from a single center in China were included. Based on preoperative glycemic status, patients were divided into three groups: nondiabetic group (NDG, n = 41), short-duration diabetic group (SDG, preoperative diabetes duration ≤12 months, n = 22), and long-duration diabetic group (LDG, preoperative diabetes duration >12 months, n = 30). Perioperative and long-term follow-up data, including the survival rate, glycemic control, and insulin regimens, were evaluated. Comparative analysis with complete insulin-deficient type 1 diabetes mellitus (T1DM) was conducted.ResultsDuring hospitalization after TP, glucose values within the target (4.4-10.0 mmol/L) accounted for 43.3% of the total data, and 45.2% of the patients experienced hypoglycemic events. Patients received continuous intravenous insulin infusion during parenteral nutrition at a daily insulin dose of 1.20 ± 0.47 units/kg/day. In the long-term follow-up period, glycosylated hemoglobin A1c levels of 7.43 ± 0.76% in patients following TP, as well as time in range and coefficient of variation assessed by continuous glucose monitoring, were similar to those in patients with T1DM. However, patients after TP had lower daily insulin dose (0.49 ± 0.19 vs 0.65 ± 0.19 units/kg/day, P < 0.001) and basal insulin percentage (39.4 ± 16.5 vs 43.9 ± 9.9%, P = 0.035) than patients with T1DM, so did those using insulin pump therapy. Whether in the perioperative or long-term follow-up period, daily insulin dose was significantly higher in LDG patients than in NDG and SDG patients.ConclusionsInsulin dose in patients undergoing TP varied according to different postoperative periods. During long-term follow-up, glycemic control and variability following TP were comparable to complete insulin-deficient T1DM but with fewer insulin needs. Preoperative glycemic status should be evaluated as it could guide insulin therapy after TP.

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