Intraductal Papillary Mucinous Neoplasms and the Risk of Diabetes Mellitus in Patients Undergoing Resection Versus Observation

Abstract

Objective The aim of this study is to determine the prevalence of diabetes mellitus (DM) in patients with intraductal papillary mucinous neoplasm of the pancreas (IPMN) and compare rates of new/progressive DM between IPMN patients undergoing pancreatectomy versus observation. Methods Patients diagnosed with IPMN were identified from institutional databases, divided into two groups based on treatment type, pancreatectomy versus clinical observation, and subsequently evaluated. Standard demographic and clinicopathologic variables, fasting glucose, diabetic status, and pancreatic volume data, were obtained and compared between groups. Results One hundred thirty-four IPMN patients were identified; 103 (77 %) underwent pancreatectomy and 31 (23 %) were observed. Baseline DM rate was 18 % (24/134). This was not different between groups [17 % (17/103) resected vs. 23 % (7/31) observed, p=0.51]. Median follow-up was 53 months and new/progressive DM occurred in 37 (28 %) patients with no difference between groups [29 (28 %) resected vs. 8 (26 %) observed, p=0.74]. Among resected patients, degree of dysplasia was associated with increase risk of new/progressive DM [moderate dysplasia OR 5.76 (1.24–26.79) and severe dysplasia OR 9.43 (1.54–57.74), p=0.04], while procedure type and remnant volume were not. Conclusions The incidence and prevalence of DM among patients with IPMN was high and did not differ between resected and observed groups. Degree of dysplasia, not the amount of resected pancreas, was associated with increased risk of DM, suggesting that the presence or development of DM may be a marker of malignant progression. Confirmatory studies are required.

Acute pancreatitis in patients with pancreatic cancer

“…Recently, one possible explanation was obstruction of pancreatic ducts, [ 3 , 8 ] which resulted in the dilatation of main pancreatic duct and activated pancreatic enzymes. A similar observation was also made by other studies [ 9 , 10 ] in patients with intraductal papillary mucinous neoplasms (IPMNs) presenting with AP. They believed that AP recurring after IPMN resection was the result of sudden obstruction of the main duct by abundant mucus secretion.…”

Diabetes and Weight Loss Are Associated With Malignancies in Patients With Intraductal Papillary Mucinous Neoplasms

“…Previous studies examined mostly overweight as a potential risk factor for developing an IPMN and progression, and DM as long -1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 term complication depending on the extension of resection. [6][7][8][9] Only a few papers focused on the prevalence of preoperative DM among patients with IPMN and its potential role in the progression to high-grade dysplasia (HGD) and invasive cancer. 7,[10][11][12][13][14] By contrast, DM has been much better investigated in PDAC, where it seems to play a double role: as risk factor for PDAC, but also as manifestation/consequence of pancreatic cancer.…”

McCune–Albright syndrome and type 1 diabetes mellitus: a novel presentation

“…Furthermore, activating GNAS mutations in codon 201 have been reported in pancreatic tumors, specifically in intraductal papillary mucinous neoplasms (IPMNs) . Despite involving pancreatic exocrine tissue, an increased incidence of nonautoimmune DM in patients with IPMNs has been identified . One suggested reason for this is that IPMN results in obstruction of the pancreatic ductal system, with induction of low‐grade pancreatitis distal to the lesion, parenchymal atrophy, and ultimately, endocrine dysfunction .…”

“…17 Despite involving pancreatic exocrine tissue, an increased incidence of nonautoimmune DM in patients with IPMNs has been identified. [18][19][20] One suggested reason for this is that IPMN results in obstruction of the pancreatic ductal system, with induction of low-grade pancreatitis distal to the lesion, parenchymal atrophy, and ultimately, endocrine dysfunction. 21 Although the exact etiology of DM in these patients remains unclear, there appears to be an indirect relationship between increased GNAS expression with IPMN development and nonautoimmune DM.…”