Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection

Nockel, Pavel; Tirosh, Amit; Lakis, Mustapha El; Gaitanidis, Apostolos; Merkel, Roxanne; Patel, Daxesh P.; Nilubol, Naris; Sadowski, Samira M.; Cochran, Craig; Görden, Phillip; Kebebew, Electron

doi:10.1007/s12020-018-1633-1

Cited by 13 publications

(16 citation statements)

References 15 publications

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“…22 Although its duration and significance in human medicine is unclear, most studies suggest it is usually transient and self-resolves in 3 to 9 days. 18 In a recent study in people, the prevalence of hyperglycemia was 36%, 24 and no significant difference in age, sex, tumor size, or surgical approach were noted between human patients with normoglycemia and those that were hyperglycemic during the postoperative period. 24 In dogs, postoperative transient hyperglycemia has been commonly recognized, and it has been associated with a better prognosis, 12 whereas the development of permanent DM is believed to be uncommon.…”

Section: Discussionmentioning

confidence: 97%

“…18 In a recent study in people, the prevalence of hyperglycemia was 36%, 24 and no significant difference in age, sex, tumor size, or surgical approach were noted between human patients with normoglycemia and those that were hyperglycemic during the postoperative period. 24 In dogs, postoperative transient hyperglycemia has been commonly recognized, and it has been associated with a better prognosis, 12 whereas the development of permanent DM is believed to be uncommon. 7 In our study, postoperative hyperglycemia was identified in 16 dogs (33%), of which, 7/48 had transient hyperglycemia and 9/48 developed persistent DM.…”

Section: Discussionmentioning

confidence: 97%

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Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma

Busto

German

Treggiari

et al. 2020

Veterinary Internal Medicne

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Background: Information regarding outcome of dogs undergoing surgical management for insulinoma is based on studies of a small number of dogs.Objectives: To report the outcomes of dogs undergoing surgery as treatment for insulinoma, the prevalence of postoperative diabetes mellitus (DM) in this group and to determine if development of DM can be predicted. Animals: Forty-eight client-owned dogs, with a histopathological diagnosis of insulinoma, from three European referral hospitals. Methods: Retrospective observational study. Dogs were identified from a search of electronic hospital records. Cox's regression was used to determine factors associated with postoperative survival and relapse, and logistic regression was used to determine factors associated with the development of DM. Results: Median survival time (MST) was 372 days (range 1-1680 days), with dogs with stage I disease having the longest survival time. Stage I dogs had MST of 652 days (range 2-1680 days), whereas dogs with either stage II or III disease had MST of 320 days (range 1-1260 days; P = 0.045). Postoperative hyperglycemia was identified in 33% (16/48) of the dogs, of which 9 (19% of the total population) developed persistent DM. No factors that could be used as predictors for development of DM were identified.Conclusions and clinical importance: Stage of disease and postoperative hypoglycemia were associated with greater odds of relapse and decreased survival time; these could be used when discussing prognosis. In this study, postoperative DM developed more commonly than previously reported, but no factors were identified that might be useful predictors.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma

Busto

German

Treggiari

et al. 2020

Veterinary Internal Medicne

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“…The blood glucose level occasionally tends to increase after insulinoma resection, a phenomenon known as rebound hyperglycemia [10] which is attributed to atrophy of the remaining pancreatic beta cells [11] or surgically induced pancreatic damage [10]. Our patient showed no signs of rebound hyperglycemia and required infrequent insulin boluses (Fig.…”

Section: Discussionmentioning

confidence: 72%

Intraoperative glycemic control using an artificial endocrine pancreas in a patient with a recurrent pleural solitary fibrous tumor producing insulin-like growth factor 2: a case report

et al. 2019

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Background: Non-islet cell tumor producing insulin-like growth factor 2 involves hypoglycemia. During tumor resection, intense fluctuation of blood glucose level may occur. An artificial endocrine pancreas has been reported as beneficial for patients with insulinoma as it maintains stable glycemic levels, although scarcely described with insulin-like growth factor 2-releasing tumor. Case presentation: An 84-year-old man had a recurrent left pleural solitary fibrous tumor releasing high molecular weight insulin-like growth factor 2 and experienced a frequent syncope accompanied by hypoglycemia. After anesthesia induction, an artificial endocrine pancreas, STG-55, was connected to the patient. Blood glucose level was stable at around 150 mg/dl during the resection surgery. The patient followed an uneventful course and was discharged without any complications. Conclusions: An artificial endocrine pancreas may have the potential to stabilize the intraoperative blood glucose change in insulin-like growth factor 2-releasing tumor resection.

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“…3 In this context, abrupt discontinuation of intravenous insulin led to RH in over 90% of the observed individuals. RH has also been observed in patients without diabetes after resection of insulinomas 4 or after enteral feeding. 5 The use of continuous glucose monitoring (CGM) systems in diabetes management is increasing, and adoption of realtime CGM (rtCGM) systems is associated with sustainable improvements in hemoglobin A1c.…”

Section: Introductionmentioning

confidence: 90%

Mitigation of Rebound Hyperglycemia With Real-Time Continuous Glucose Monitoring Data and Predictive Alerts

Acciaroli

Welsh

Aktürk

2021

J Diabetes Sci Technol

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Background: Excess carbohydrate intake during hypoglycemia can lead to rebound hyperglycemia (RH). We investigated associations between RH and use of real-time continuous glucose monitoring (rtCGM) and an rtCGM system’s predictive alert. Methods: RH events were series of sensor glucose values (SGVs) >180 mg/dL starting within two hours of an antecedent SGV <70 mg/dL. Events were characterized by their frequency, duration (consecutive SGVs >180 mg/dL × five minutes), and severity (area under the glucose concentration-time curve). To assess the impact of rtCGM, data gathered during the four-week baseline phase (without rtCGM) and four-week follow-up phase (with rtCGM) from 75 participants in the HypoDE clinical trial (NCT02671968) of hypoglycemia-unaware individuals were compared. To assess the impact of predictive alerts, we identified a convenience sample of 24 518 users of an rtCGM system without predictive alerts who transitioned to a system whose predictive alert signals an SGV ≤55 mg/dL within 20 minutes (Dexcom G5 and G6, respectively). RH events from periods of blinded versus unblinded rtCGM wear and from periods of G5 and G6 wear were compared with paired t tests. Results: Compared to RH events in the HypoDE baseline phase, the mean frequency, duration, and severity of events fell by 14%, 12%, and 23%, respectively, in the follow-up phase (all P < .05). Compared to RH events during G5 use, the mean frequency, duration, and severity of events fell by 7%, 8%, and 13%, respectively, during G6 use (all P < .001). Conclusions: Rebound hypreglycemia can be objectively quantified and mitigated with rtCGM and rtCGM-based predictive alerts.

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Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection

Abstract: Hyperglycemia is common after insulinoma resection, and a subset of patients require transient treatment with insulin.

Cited by 13 publications

References 15 publications

Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma

Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma

Intraoperative glycemic control using an artificial endocrine pancreas in a patient with a recurrent pleural solitary fibrous tumor producing insulin-like growth factor 2: a case report

Mitigation of Rebound Hyperglycemia With Real-Time Continuous Glucose Monitoring Data and Predictive Alerts

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