Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms After Total Pancreatectomy

Struyvenberg, Maarten R.; Fong, Zhi Ven; Martin, Camilia R.; Tseng, Jennifer F.; Clancy, Thomas E.; Castillo, Carlos Fernández‐del; Tillman, Hanna; Bellin, Melena D.; Freedman, Steven D.

doi:10.1097/mpa.0000000000000917

Cited by 19 publications

(11 citation statements)

References 38 publications

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confidence: 99%

“…Moreover, recent studies have reported improved perioperative outcomes and postoperative QoL after TP, presumably due to centralization at high-volume centers and development of long-acting insulin and modern pancreatic enzyme preparations. [10][11][12][13][14] Postoperative pancreatic fistula (POPF) is the main cause of surgical morbidity after pancreatoduodenectomy (PD). Several risk score systems based on pre-and intraoperative parameters, such as the fistula risk score (FRS) or the alternative fistula risk score (a-FRS), have been proposed to predict the occurrence of POPF and stratify patients based on this risk.…”

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confidence: 99%

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High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

Marchegiani

Perri²,

Burelli³

et al. 2021

Annals of Surgery

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Objective: To evaluate TP as an alternative to PD in patients at high-risk for popf. Background: Outcomes of high-risk PD (HR-PD) and TP have never been compared. Methods: All patients who underwent PD or TP between July 2017 and December 2019 were identified. HR-PD was defined according to the alternative fistula risk score. Postoperative outcomes (primary endpoint), pancreatic insufficiency, and quality of life after 12 months of follow-up (QoL) were compared between HR-PD or planned PD intraoperatively converted to TP (C-TP). Results: A total of 566 patients underwent PD and 136 underwent TP during the study period. One hundred one (18%) PD patients underwent HR-PD, whereas 86 (63%) TP patients underwent C-TP. Postoperatively, the patients in the C-TP group exhibited lower rates of postpancreatectomy hemorrhage (15% vs 28%), delayed gastric emptying (16% vs 34%), sepsis (10% vs 31%), and Clavien-Dindo ≥3 morbidity (19% vs 31%) and had shorter median lengths of hospital stay (10 vs 21 days) (all P < 0.05). The rate of POPF in the HR-PD group was 39%. Mortality was comparable between the 2 groups (3% vs 4%). Although general, cancer- and pancreas-specific QoL were comparable between the HR-PD and C-TP groups, endocrine and exocrine insufficiency occurred in all the C-TP patients, compared to only 13% and 63% of the HR-PD patients, respectively, and C-TP patients had worse diabetesspecific QoL. Conclusions: C-TP may be considered rather than HR-PD only in few selected cases and after adequate counseling.

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confidence: 99%

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confidence: 99%

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

Marchegiani

Perri²,

Burelli³

et al. 2021

Annals of Surgery

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“…We identified no difference in glycemic control or insulin dose between the CSII group and the MDI group, but Struyvenberg et al. ( 26 ) demonstrated a significant reduction in severe hypoglycemic events in the CSII group than in the MDI group. Additionally, it was reported that artificial pancreas, sensor-augmented predictive low-glucose suspend pump and advanced hybrid closed−loop systems were efficacious and safe for perioperative and long-term glycemic control after TP ( 39 – 41 ).…”

Section: Discussionmentioning

confidence: 52%

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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“…Recently, the focus on hyperglycemia control in perioperative patients with diabetes has increased, and experience is gradually being accumulated in this regard 8 9 10 11 12 13 . An increasing number of evidences suggest the superiority of CSII over MDII during the perioperative period in patients with diabetes 14 15 . A study 16 found that compared with MDII, even short-term implementation of CSII could improve the postoperative control of glucose and reduce the incidence of postoperative fever in surgical patients with diabetes.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Insulin Pump Therapy Decreases Readmission Risk and Improves Outcomes in Patients with Diabetes

Wang,

Bai,

Chen

et al. 2024

Exp Clin Endocrinol Diabetes

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Objective To evaluate the impact of temporary insulin pump use during hospitalization on glycemia, postoperative complications, and cost/utilization in perioperative patients with diabetes. Methods Patients (n=159) with type 2 diabetes and hospitalized for elective surgery were recruited from three hospitals. Subjects were categorized into the insulin pump group and the multiple daily subcutaneous insulin injection group according to their treatment therapy. Data were collected at admission, discharge, and 3 months post-discharge. Results Subjects in the CSII group who were still on insulin therapy transitioned from CSII to MDII; however, their daily insulin dosages were lower than those in the MDII group (15.31±10.98 U/d vs. 23.48±17.02 U/d, P=0.015) after discharge. In terms of medical costs, the CSII group had significantly higher hospitalization costs than the MDII group (112.36±103.43 thousand RMB vs. 82.65±77.98 thousand RMB, P=0.043). After 3 months, the CSII group had significantly lower outpatient costs than the MDII group (3.17±0.94 thousand RMB vs. 3.98±1.76 thousand RMB, P ˂ 0.001). In the MDII group, 10 patients reported severe postoperative complications requiring re-hospitalization; there were no similar reports in the CSII group. Conclusion Temporary use of insulin pump therapy for perioperative patients with diabetes results in a reduction in blood glucose and blood glucose fluctuation during hospitalization, HbA1c, and the risk of postoperative complication and readmission, thus significantly decreasing costs in this complex patient cohort. Further work is needed to better understand indications for utilizing pump therapy based on diabetes phenotype and the complexity of planned surgical intervention.

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Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms After Total Pancreatectomy

Abstract: After TP, CSII therapy is safe compared with MDIs in T3cDM and not associated with an increase in severe hypoglycemic events. Pancreatic enzyme replacement therapy is highly variable with low doses associated with unintentional weight loss and gastrointestinal symptoms.

Cited by 19 publications

References 38 publications

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

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

Perioperative Insulin Pump Therapy Decreases Readmission Risk and Improves Outcomes in Patients with Diabetes

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