Favorable glycemic response after pancreatoduodenectomy in both patients with pancreatic cancer and patients with non-pancreatic cancer.

Abstract

Diabetes mellitus (DM) is prevalent in patients with pancreatic cancer and tends to improve after tumor resection. However, the glycemic response of non-pancreatic cancer patients after surgery has not been examined in detail. We aimed to investigate the changes in glucose metabolism in patients with pancreatic cancer or non-pancreatic cancer after pancreatoduodenectomy (PD).We prospectively enrolled 48 patients with pancreatic cancer and 56 patients with non-pancreatic cancer, who underwent PD. Glucose metabolism was assessed with fasting glucose, glycated hemoglobin (HbA1c), plasma C-peptide and insulin, quantitative insulin check index (QUICKI), and a homeostatic model assessment of insulin resistance (HOMA-IR) and β cell (HOMA-β) before surgery and 6 months after surgery. Patients were divided into 2 groups: "improved" and "worsened" postoperative glycemic response, according to the changes in HbA1c and anti-diabetic medication. New-onset DM was defined as diagnosis of DM ≤ 2 years before PD, and cases with DM diagnosis >2 years preceding PD were described as long-standing DM.After PD, insulin resistance (IR), as measured by insulin, HOMA-IR and QUICKI, improved significantly, although C-peptide and HOMA-β decreased. At 6 months after PD, new-onset DM patients showed improved glycemic control in both pancreatic cancer patients (75%) and non-pancreatic cancer patients (63%). Multivariate analysis showed that long-standing DM was a significant predictor for worsening glucose control (odds ratio = 4.01, P = .017).Favorable glycemic control was frequently observed in both pancreatic cancer and non-pancreatic cancer after PD. PD seems to contribute improved glucose control through the decreased IR. New-onset DM showed better glycemic control than long-standing DM.

• Authors: Seo Young Sohn, Eun Kyung Lee, Sung-Sik Han, You Jin Lee, Yul Hwangbo, Young Hwa Kang, Seung Duk Lee, Seong Hoon Kim, Sang Myung Woo, Woo Jin Lee, Eun Kyung Hong, Sang-Jae Park
• Journal: Medicine (Medicine (Baltimore)) Vol. 97 Issue 18 Pg. e0590 (May 2018) ISSN: 1536-5964 [Electronic] United States
• PMID: 29718860 (Publication Type: Journal Article, Observational Study)

Chemical References

• Blood Glucose
• C-Peptide
• Glycated Hemoglobin A
• Insulin

Topics

• Aged
• Ampulla of Vater (surgery)
• Blood Glucose (metabolism)
• C-Peptide (blood)
• Common Bile Duct Neoplasms (blood, surgery)
• Diabetes Mellitus (blood)
• Duodenal Neoplasms (blood, surgery)
• Female
• Glycated Hemoglobin (metabolism)
• Humans
• Insulin (blood)
• Insulin Resistance
• Male
• Middle Aged
• Pancreatic Neoplasms (blood, surgery)
• Pancreaticoduodenectomy