Diabetes management in patients undergoing total pancreatectomy: A single center cohort study
Open accessAbstract
Background: Total pancreatectomy (TP) has been increasingly performed in recent years. However, studies on diabetes management after TP during different postoperative periods are still limited. Objectives: This study aimed to evaluate the glycemic control and insulin therapy of patients undergoing TP during the perioperative and long-term follow-up period. Methods: Ninety-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. Results: During 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 A1 c 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. Conclusions: Insulin 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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Diabetes type 3c is mainly characterized by an extraordinary insulin sensitivity, which can be explained in terms of the missing counterregulatory glucagon.
“Diabetes type 3c is mainly characterized by an extraordinary insulin sensitivity, which can be explained in terms of the missing counterregulatory glucagon [32-36].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [35]
The Discussion (page not available) reports lower insulin needs after total pancreatectomy than in comparable patients with type 1 diabetes and says these may reflect increased peripheral insulin sensitivity and deficient pancreatic-glucagon counterregulation. It also names malabsorption as a possible contributor. The source therefore supports the proposed link, but not the claim that extraordinary insulin sensitivity chiefly characterizes all type 3c diabetes or that missing glucagon alone explains it. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the pre-CGM era, total loss of glycemic control was associated with severe complications in patients undergoing total pancreatectomy.
“In the pre-CGM era, the total loss of glycemic control was associated with severe complications in patients undergoing total pancreatectomy [35,66,69].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [35]
The Introduction (page unavailable) reports that early postoperative fasting glucose was an independent risk factor for complications after total pancreatectomy. It does not place that association in a pre-CGM era, describe a total loss of glycemic control, or specify that the complications were severe. (LLM, conf=0.83)
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“A current review article by Zhao and colleagues provides an in-depth discussion of this topic [35].”
BackgroundMalnutrition and diabetes outcomes 12 months after total pancreatectomy: A descriptive cohort study
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- Authors
- Zhao, T., Fu, Y., Zhang, T., Guo, J., Liao, Q., Song, S., Duo, Y., Gao, Y., Yuan, T., & Zhao, W.
- Affiliations
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Corresponding author
- Yuan, Tao
- Zhao, Weigang
- ORCID
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2023-02-13
- Volume
- 14
- Pages
- 1097139-1097139
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC9969079
- OpenAlex
- W4320494405
- Cited by
- 18
- References
- 44
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 3 · 2023: 3
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Chinese Academy of Medical Sciences
- National Science and Technology Major Project (2019ZX09734001)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Keywords
- total pancreatectomy, diabetes management, glycemic control, insulin therapy, insulin dose, hypoglycemia, continuous glucose monitoring, insulin pump therapy, HbA1c, basal insulin, perioperative period, long-term follow-up, survival rate, parenteral nutrition
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 1, Glucose, Humans, Insulin, Pancreatectomy, Blood Glucose Self-Monitoring, Cohort Studies
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