diabetestalk.net

Pancreatogenic Diabetes After Pancreatic Resection

Pancreatogenic Diabetes After Pancreatic Resection

Pancreatogenic Diabetes After Pancreatic Resection

Pancreatogenic Diabetes after Pancreatic Resection I have read the Karger Terms and Conditions and agree. I have read the Karger Terms and Conditions and agree. Buy a Karger Article Bundle (KAB) and profit from a discount! If you would like to redeem your KAB credit, please log in . Save over 20% compared to the individual article price. Buy Cloud Access for unlimited viewing via different devices For eJournal Archive and eJournal Backfiles information please contact [email protected] * The final prices may differ from the prices shown due to specifics of VAT rules. For additional information: The loss of pancreatic parenchyma resulting from pancreatic resection causes an extreme disruption of glucose homeostasis known as pancreatogenic diabetes. This form of glucose intolerance is different from the other forms of diabetes mellitus in that affected individuals suffer frequent episodes of iatrogenic hypoglycemia. The development of sophisticated surgical procedures, improved postoperative care, and the capacity for early diagnosis of disease has prolonged life expectancy after pancreatic resection. For this reason, pancreatogenic diabetes is now attracting attention as the primary factor influencing quality of life in patients who have undergone this procedure. The incidence of new-onset diabetes mellitus after pancreatic resection increases as the follow-up period after surgery becomes longer and is related to the progression of underlying disease, the type of surgery, and the extent of resection. The pathophysiology of pancreatogenic diabetes is related to pancreatic hormone deficiency and the altered responses of the liver and peripheral organs to lower than normal hormone levels. Hyperglycemia occurs when the amount of insulin produced or administered is insuffici Continue reading >>

Incidence And Severity Of Pancreatogenic Diabetes After Pancreatic Resection (englisch)

Incidence And Severity Of Pancreatogenic Diabetes After Pancreatic Resection (englisch)

Prognostic Significance of Metastatic Lymph Node Number, Ratio and Station in Gastric Neuroendocrine Carcinoma Tang, Xiaolong / Chen, Yingtai / Guo, Lanwei / Zhang, Jianwei / Wang, Chengfeng | 2014 Inverse Association Between Visceral Obesity and Lymph Node Metastasis in Gastric Cancer Park, Se Woo / Lee, Hang Lak / Ju, Yong Won / Jun, Dae Won / Lee, Oh Young / Han, Dong Soo / Yoon, Byung Chul / Choi, Ho Soon / Hahm, Joon Soo | 2014 Estimates of Conditional Survival in Gastric Cancer Reveal a Reduction of Racial Disparities with Long-Term Follow-Up Luyimbazi, David / Nelson, Rebecca A. / Choi, Audrey H. / Li, Lily / Chao, Joseph / Sun, Virginia / Hamner, John B. / Kim, Joseph | 2014 Current Recommendations for Surveillance and Surgery of Intraductal Papillary Mucinous Neoplasms May Overlook Some Patients with Cancer Nguyen, Andrew H. / Toste, Paul A. / Farrell, James J. / Clerkin, Barbara M. / Williams, Jennifer / Muthusamy, V. Raman / Watson, Rabindra R. / Tomlinson, James S. / Hines, O. Joe / Reber, Howard A. et al. | 2014 Risk Factors for 30-day Readmissions after Hepatectomy: Analysis of 2444 Patients from the ACS-NSQIP Database Kim, Sooyeon / Maynard, Erin C. / Shah, Malay B. / Daily, Michael F. / Tzeng, Ching-Wei D. / Davenport, Daniel L. / Gedaly, Roberto | 2014 Sarcopenia Adversely Impacts Postoperative Complications Following Resection or Transplantation in Patients with Primary Liver Tumors Valero, Vicente III / Amini, Neda / Spolverato, Gaya / Weiss, Matthew J. / Hirose, Kenzo / Dagher, Nabil N. / Wolfgang, Christopher L. / Cameron, Andrew A. / Philosophe, Benjamin / Kamel, Ihab R. et al. | 2014 Clinical Outcomes and Costs Associated with In-hospital Biliary Complications After Liver Transplantation: a Cross-Sectional Analysis Palanisamy, Arun P. / Taber, D. Continue reading >>

Diabetes And Pancreatic Cancer

Diabetes And Pancreatic Cancer

Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 1Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China (Correspondence should be addressed to D K Andersen who is now at Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building DEM2, Room 659, 6707 Democracy Boulevard, Bethesda, Maryland 20892, USA; Email: andersendk{at}niddk.nih.gov) Epidemiological studies clearly indicate that the risk of pancreatic cancer (PC) is increased in diabetic patients, but most studies focus on overall diabetes or type 2 diabetes mellitus (T2DM), and there are few studies on the risks of type 1 and type 3c (secondary) diabetes. Possible mechanisms for increased cancer risk in diabetes include cellular proliferative effects of hyperglycemia, hyperinsulinemia, and abnormalities in insulin/IGF receptor pathways. Recently, insulin and insulin secretagogues have been observed to increase the PC risk, while metformin treatment reduces the cancer risk in diabetic subjects. In addition, anticancer drugs used to treat PC may either cause diabetes or worsen coexisting diabetes. T3cDM has emerged as a major subset of diabetes and may have the highest risk of pancreatic carcinoma especially in patients with chronic pancreatitis. T3cDM is also a consequence of PC in at least 30% of patients. Distinguishing T3cDM from the more prevalent T2DM among new-onset diabetic patients can be aided by an assessment of clinical features and confirmed by finding a deficiency in postprandial pancreatic polypeptide release. In conclusion, diabetes and PC have a complex rela Continue reading >>

Pancreatogenic Diabetes After Pancreatic Resection

Pancreatogenic Diabetes After Pancreatic Resection

Volume 11, Issue 2 , August 2011, Pages 268-276 Pancreatogenic Diabetes after Pancreatic Resection Author links open overlay panel HiromichiMaedaab KazuhiroHanazakia1 Get rights and content The loss of pancreatic parenchyma resulting from pancreatic resection causes an extreme disruption of glucose homeostasis known as pancreatogenic diabetes. This form of glucose intolerance is different from the other forms of diabetes mellitus in that affected individuals suffer frequent episodes of iatrogenic hypoglycemia. The development of sophisticated surgical procedures, improved postoperative care, and the capacity for early diagnosis of disease has prolonged life expectancy after pancreatic resection. For this reason, pancreatogenic diabetes is now attracting attention as the primary factor influencing quality of life in patients who have undergone this procedure. The incidence of new-onset diabetes mellitus after pancreatic resection increases as the follow-up period after surgery becomes longer and is related to the progression of underlying disease, the type of surgery, and the extent of resection. The pathophysiology of pancreatogenic diabetes is related to pancreatic hormone deficiency and the altered responses of the liver and peripheral organs to lower than normal hormone levels. Hyperglycemia occurs when the amount of insulin produced or administered is insufficient because of unsuppressed hepatic glucose production secondary to a deficiency in pancreatic polypeptide. In contrast, patients lapse into hypoglycemia when insulin is barely excessive because of enhanced peripheral insulin sensitivity and glucagon deficiency. Nutritional state, pancreatic exocrine function and intestinal function also affect glycmic control. Insulin replacement is considered to be the main Continue reading >>

Incidence And Severity Of Pancreatogenic Diabetes After Pancreatic Resection

Incidence And Severity Of Pancreatogenic Diabetes After Pancreatic Resection

01.02.2015 | 2014 SSAT Quick Shot Presentation | Ausgabe 2/2015 Incidence and Severity of Pancreatogenic Diabetes After Pancreatic Resection Journal of Gastrointestinal Surgery > Ausgabe 2/2015 Richard A. Burkhart, Susan M. Gerber, Renee M. Tholey, Kathleen M. Lamb, Anitha Somasundaram, Caitlin A. McIntyre, Eliza C. Fradkin, Annie P. Ashok, Robert F. Felte, Jaya M. Mehta, Ernest L. Rosato, Harish Lavu, Serge A. Jabbour, Charles J. Yeo, Jordan M. Winter While many patients experience prolonged survival after pancreatic resection for benign or malignant disease, the long-term risk of pancreatogenic diabetes mellitus (DM) remains poorly characterized. One thousand one hundred seven patients underwent pancreatectomy at Thomas Jefferson University between 2006 and 2013. Attempts were made to contact all living patients by telephone and a DM-focused questionnaire was administered. Two hundred fifty-nine of 691 (37 %) surviving patients completed the survey, including 179 pancreaticoduodenectomies (PD), 78 distal pancreatectomies (DP), and 2 total pancreatectomies. In the PD group, 44 (25%) patients reported having DM prior to resection. Of these, 5 (12%) had improved glucose control after resection and 21 (48%) reported escalated DM medication requirements post-resection. Of 135 PD patients without preoperative DM, 24 (18%) had new-onset DM postoperatively. In the DP group, 23 patients (29%) had DM preoperatively. None had improved glucose control after resection, while six (26%) had worse control after resection. Seventeen of 55 DP patients (31%) without preoperative DM developed new-onset DM postoperatively (p = 0.04 vs. PD). Preoperative HgbA1C >6.0%, glucose >124mg/dL, and insulin use >2 units per day were associated with an increased risk of new-onset postoperative DM. Continue reading >>

Population-level Incidence And Predictors Of Surgically Induced Diabetes And Exocrine Insufficiency After Partial Pancreatic Resection

Population-level Incidence And Predictors Of Surgically Induced Diabetes And Exocrine Insufficiency After Partial Pancreatic Resection

Population-Level Incidence and Predictors of Surgically Induced Diabetes and Exocrine Insufficiency after Partial Pancreatic Resection Context: Endocrine and exocrine insufficiency after partial pancreatectomy affect quality of life, cardiovascular health, and nutritional status. However, their incidence and predictors are unknown. Objective: To identify the incidence and predictors of new-onset diabetes and exocrine insufficiency after partial pancreatectomy. Design: We retrospectively reviewed 1165 cases of partial pancreatectomy, performed from 1998 to 2010, from a large population-based database. Main Outcome Measures: Incidence of new onset diabetes and exocrine insufficiency Results: Of 1165 patients undergoing partial pancreatectomy, 41.8% had preexisting diabetes. In the remaining 678 patients, at a median 3.6 months, diabetes developed in 274 (40.4%) and pancreatic insufficiency developed in 235 (34.7%) patients. Independent predictors of new-onset diabetes were higher Charlson Comorbidity Index (CCI; hazard ratio [HR] = 1.62 for CCI of 1, p = 0.02; HR = 1.95 for CCI 2, p < 0.01) and pancreatitis (HR = 1.51, p = 0.03). There was no difference in diabetes after Whipple procedure vs distal pancreatic resections, or malignant vs benign pathologic findings. Independent predictors of exocrine insufficiency were female sex (HR = 1.32, p = 0.002) and higher CCI (HR = 1.85 for CCI of 1, p < 0.01; HR = 2.05 for CCI 2, p < 0.01). Distal resection and Asian race predicted decreased exocrine insufficiency (HR = 0.35, p<0.01; HR =0.54, p < 0.01, respectively). Conclusion: In a large population-based database, the rates of postpancreatectomy endocrine and exocrine insufficiency were 40% and 35%, respectively. These data are critical for informing patients and physicians exp Continue reading >>

Mini-review On The Glucose Metabolism Modifications After Pancreatic Resection

Mini-review On The Glucose Metabolism Modifications After Pancreatic Resection

Mini-Review on the Glucose Metabolism Modifications after Pancreatic Resection Subscribe to our Newsletter and get informed about new publication regulary and special discounts for subscribers! Pancreatic cancer is one of the most severe malignant disease, with an extreme degree of lethality, considering that the survival rate at 5 years is up to 4%. In addition, a major disadvantage of this disease is the fact that the diagnosis is determined very late in the evolution of the disorder, despite the development of new technologies. In this way, the main symptoms are occurring later on, when the tumour is already locally advanced and unresectable. Up to now surgery is the only modality that can provide a greater chance of survival, but unfortunately the pancreatic resection has many unknowns and controversies around it. Moreover, the studies on endocrine pancreatic function after resection are very few and somehow controversial. In this way, in the present mini-review we will describe the most relevant experimental data regarding the post-resection pancreatogenic diabetes, the pancreatic polypeptide PP and the pancreatic glucose metabolism after resection or the glucose metabolism after partial or total pancreatectomy. International Letters of Natural Sciences (Volume 53) D. Timofte et al., "Mini-Review on the Glucose Metabolism Modifications after Pancreatic Resection", International Letters of Natural Sciences, Vol. 53, pp. 65-71, 2016 Please note that your's default visibility preference will be used for this work. You can always change your default visibility preference in your ORCID profile . [1] V. Surlin, V. Bintintan, F. Petrariu, R. Dobrin, R. Lefter, A. Ciobic, D. Timofte, Prognostic factors in resectable pancreatic cancer, Rev Med Chir Soc Med Nat Iasi. 118 (2 Continue reading >>

Predicting New-onset Diabetes After Minimally Invasive Subtotal Distal Pancreatectomy In Benign And Borderline Malignant Lesions Of The Pancreas

Predicting New-onset Diabetes After Minimally Invasive Subtotal Distal Pancreatectomy In Benign And Borderline Malignant Lesions Of The Pancreas

Received 2017 September 13; Revised 2017 November 28; Accepted 2017 November 29. Copyright 2017 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. The purpose of this study was to evaluate the time-dependent probability and risk factors of pancreatogenic diabetes mellitus (PDM) in patients who underwent minimally invasive subtotal distal pancreatectomy. Changes in glucose metabolic consequence of 34 patients (laparoscopic: 31, robotic: 3) who underwent surgery from December 2005 to December 2014 were estimated by assessing impaired fasting glucose, PDM, and PDM-free time analysis. A total of 22 patients showed glucose intolerance, including 13 (38.2%) with impaired fasting glucose and 9 (26.5%) with PDM. The median onset time of PDM was 6.8 months (range 5.313.2 months). The PDM-free time probability according to time interval was 94.1% (6 months), 75.9% (12 months), and 72.6% (18 months). It was shown that body mass index>23 6.172; 95% confidence interval, 1.53224.865; P .010) was significantly associated with short PDM-free time in Cox proportional hazards model. Patients with high cholesterol levels and high BMI should be closely monitored for the development of PDM. Keywords: diabetes mellitus, distal pancreatectomy, subtotal distal pancreatectomy When a tumor is detected in the neck or proximal body of the pancreas, surgeons encounter the dilemma of whether to perform central pancreatectomy or distal pancreatectomy (DP) with divisio Continue reading >>

Pancreatogenic Diabetes After Pancreatic Resection.

Pancreatogenic Diabetes After Pancreatic Resection.

Pancreatogenic diabetes after pancreatic resection. Department of Surgery, Kochi University, Nankoku City, Japan. Pancreatology. 2011;11(2):268-76. doi: 10.1159/000328785. Epub 2011 Jul 5. The loss of pancreatic parenchyma resulting from pancreatic resection causes an extreme disruption of glucose homeostasis known as pancreatogenic diabetes. This form of glucose intolerance is different from the other forms of diabetes mellitus in that affected individuals suffer frequent episodes of iatrogenic hypoglycemia. The development of sophisticated surgical procedures, improved postoperative care, and the capacity for early diagnosis of disease has prolonged life expectancy after pancreatic resection. For this reason, pancreatogenic diabetes is now attracting attention as the primary factor influencing quality of life in patients who have undergone this procedure. The incidence of new-onset diabetes mellitus after pancreatic resection increases as the follow-up period after surgery becomes longer and is related to the progression of underlying disease, the type of surgery, and the extent of resection. The pathophysiology of pancreatogenic diabetes is related to pancreatic hormone deficiency and the altered responses of the liver and peripheral organs to lower than normal hormone levels. Hyperglycemia occurs when the amount of insulin produced or administered is insufficient because of unsuppressed hepatic glucose production secondary to a deficiency in pancreatic polypeptide. In contrast, patients lapse into hypoglycemia when insulin is barely excessive because of enhanced peripheral insulin sensitivity and glucagon deficiency. Nutritional state, pancreatic exocrine function and intestinal function also affect glycemic control. Insulin replacement is considered to be the main Continue reading >>

Glycemic Control After Total Pancreatectomy For Intraductal Papillary Mucinous Neoplasm: An Exploratory Study

Glycemic Control After Total Pancreatectomy For Intraductal Papillary Mucinous Neoplasm: An Exploratory Study

Glycemic Control after Total Pancreatectomy for Intraductal Papillary Mucinous Neoplasm: An Exploratory Study 1Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA 2Division of Endocrinology, Mayo Clinic, Jacksonville, FL 32224, USA 3Department of Surgery, Mayo Clinic, Jacksonville, FL 32224, USA 4Biostatistics Unit, Mayo Clinic, Jacksonville, FL 32224, USA 5Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA Received 30 April 2012; Accepted 3 July 2012 Copyright 2012 Laith H. Jamil et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN) is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C) at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, ). Six out of seven TP patients (86%) who experienced a hypoglycemic episode treated the episode themselves at home, compared to 59 type I DM patients (91%). The remaining 6 type I DM patients (9%) received treatment at a hospital compared to 1 TP patient who required admission to the emergency room, where she was treated with intravenous Continue reading >>

Papers With The Keyword Pancreatogenic Diabetes (page 2) | Read By Qxmd

Papers With The Keyword Pancreatogenic Diabetes (page 2) | Read By Qxmd

Total Pancreatectomy With Islet Cell Transplantation for the Treatment of Pancreatic Cancer. Resection or removal of the pancreas causes loss of parenchyma, which can result in extreme disruption of glucose homeostasis and malabsorption of dietary nutrients. However, islet autotransplantation (IAT) may reduce or prevent the severity of pancreatogenic diabetes. This article explores total pancreatectomy with IAT within the context of pancreatic cancer treatment. At a Glance The liver is the preferred site for implantation because of easy vascular access. Following islet autotransplantation, the liver becomes an insulin-producing organ as the transplanted beta cells begin making insulin... Glycemic Change After Pancreaticoduodenectomy: A Population-Based Study. Jin-Ming Wu, Te-Wei Ho, Ting-Chun Kuo, Ching-Yao Yang, Hong-Shiee Lai, Pin-Yi Chiang, Su-Hua Hsieh, Feipei Lai, Yu-Wen Tien The purpose of this population-based study was to determine the change of glucose metabolism in patients undergoing pancreaticoduodenectomy (PD).We conducted a nationwide cohort study using data from Taiwan's National Health Insurance Research Database collected between 2000 and 2010. Our sample included 861 subjects with type 2 diabetes mellitus (DM) and 3914 subjects without DM.Of 861 subjects with type 2 diabetes, 174 patients (20.2%) experienced resolution of their diabetes after PD, including patients with pancreatic ductal adenocarcinoma (PDAC) (20... Development of Autoimmune-Mediated Cell Failure After Total Pancreatectomy With Autologous Islet Transplantation. M D Bellin, A Moran, J J Wilhelm, T D O'Brien, P A Gottlieb, L Yu, T B Dunn Total pancreatectomy with islet autotransplantation (TPIAT) is performed for definitive treatment of chronic pancreatitis; patients are not diabetic be Continue reading >>

[full Text] Management Of Pancreatogenic Diabetes: Challenges And Solutions | Dmso

[full Text] Management Of Pancreatogenic Diabetes: Challenges And Solutions | Dmso

Editor who approved publication: Professor Ming-Hui Zou Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia Abstract: Pancreatogenic diabetes is an underdiagnosed form of secondary diabetes that is lacking official management guidelines. This paper reviews the recommended management strategies with additional data on the promising novel drugs. Keywords: T3cDM, pancreatogenic diabetes, diabetes management, brittle diabetes, hypoglycemia Pancreatogenic diabetes is a form of secondary diabetes, classified by the American Diabetes Association (ADA) and the World Health Organization as type 3c diabetes mellitus (T3cDM). 1 , 2 It refers to diabetes due to diseases of the exocrine pancreas: pancreatitis (acute, relapsing, or chronic pancreatitis of any etiology), pancreatectomy/trauma, neoplasia, cystic fibrosis, hemochromatosis, and fibrocalculous pancreatopathy. 3 With the exception of cancer, damage to the pancreas must be extensive enough for diabetes to occur. 1 , 2 Rather scarce data on T3cDM suggest that most cases result from chronic pancreatitis, as this condition was identified as the underlying disease in 78.5% of all patients with T3cDM. 4 In Western populations, T3cDM is estimated to occur in 5%10% of all diabetic patients, mostly due to chronic pancreatitis. 4 6 True prevalence of T3cDM is unknown data are scarce, mostly due to challenges with accurate diabetes classification in clinical practice. 4 , 7 9 Many T3cDM patients are initially misclassified due to underrecognized contribution of pancreatic disease to the development of diabetes. In order to improve diagnosis, diagnostic criteria for T3cDM have been proposed by Ewald and Bretzel which include 1) the presence of pancreatic exocrine insufficiency, 2)evidence of pat Continue reading >>

Wear Your Detective Hat For Postpancreatectomy Diabetes Mellitus

Wear Your Detective Hat For Postpancreatectomy Diabetes Mellitus

Wear Your Detective Hat for Postpancreatectomy Diabetes Mellitus Following guidelines and asking questions are key to solving the T3cDM coding mystery. One guideline in ICD-10-CM consistently overlooked is I.C.4.a.6.b.i., which is specific to secondary diabetes mellitus due to a pancreatectomy. I.C.4.a.6.b.i. Secondary diabetes mellitus due to a pancreatectomy For postpancreatectomy diabetes mellitus (lack of insulin due to the surgical removal of all or part of the pancreas), assign code E89.1, Postprocedural hypoinsulinemia. Assign a code from category E13 and a code from subcategory Z90.41-, Acquired absence of pancreas, as additional codes. This guideline prompts a number of questions that must be answered before a thorough understanding can be attained. Why is this type of diabetes assigned to category E13 rather than category E08? E08 Diabetes mellitus due to underlying condition You may argue absence of some or the entire pancreas would be an underlying condition and that is correct. But if you look at how the categories of diabetes are divided in ICD-10-CM, you find category E13 pulls several underlying conditions out from category E08. Specifically, if the underlying condition is genetic (affecting beta-cell function or insulin action), surgical, or a condition not included in another category, it is coded to category E13. This understanding prompts two more questions: Why is postpancreatectomy diabetes mellitus included in category E13? What specifically makes this type of diabetes different from the other categories? According to Managing Diabetes and Hyperglycemia in the Hospital Setting, A Clinicians Guide (B. Draznin), postpancreatectomy diabetes mellitus is classified, along with a few other conditions, into its own type of diabetes mellitus, commonly re Continue reading >>

Ssat - The Incidence Of Pancreatogenic Diabetes After Major Partial Pancreatic Resection May Be Greater Than You Think

Ssat - The Incidence Of Pancreatogenic Diabetes After Major Partial Pancreatic Resection May Be Greater Than You Think

The Incidence of Pancreatogenic Diabetes After Major Partial Pancreatic Resection May Be Greater Than You Think Richard a. Burkhart*1, Susan M. Gerber2, Renee Tholey1, Kathleen Lamb1, Anitha Somasundaram2, Caitlin Mcintyre1, Eliza Fradkin2, Annie Ashok2, Robert Felte1, Jaya Mehta2, Ernest L. Rosato1, Harish Lavu1, Serge a. Jabbour2, Charles J. Yeo1, Jordan M. Winter1 1Surgery, Thomas Jefferson University, Philadelphia, PA; 2Endocrinology, Thomas Jefferson University, Philadelphia, PA Background: The number of pancreatic resections performed each year in the United States according to the Nationwide Inpatient Sample is growing (currently around 5000). Nearly half of the patients undergoing resection (many with benign disease) will experience prolonged survival (>2 years), yet the long-term risk of pancreatogenic (type III) diabetes remains unknown. Previous estimates from small studies outside of the U.S. suggest a risk between 10-20%. Methods: After IRB approval, 1107 patients were identified who underwent pancreatectomy at a single institution from 2005 to 2012. Living patients were contacted by telephone, and pre- and postoperative diagnoses of diabetes mellitus (DM) were confirmed using a verbal questionnaire. Only individuals who completed the survey were included in the study. Results: Calls were made to all 691 living patients who underwent partial pancreatectomy. DM-specific information was successfully obtained for 257 patients (23% of the total cohort), including 179 pancreaticoduodenectomies (PD) and 78 distal pancreatectomies (DP). In the PD group: 44 (25%) patients reported having DM prior to resection (median onset 7 years prior, range 0.1 to 30), with 10 (6%) reporting onset within 1 year of resection. Of the group carrying a pre-operative diagnosis of DM Continue reading >>

Pancreatogenic (type 3c) Diabetes

Pancreatogenic (type 3c) Diabetes

1. Definition Pancreatogenic diabetes is a form of secondary diabetes, specifically that associated with disease of the exocrine pancreas. The most common disease of the exocrine pancreas associated with the development of diabetes is chronic pancreatitis. Analogous to chronic pancreatitis-associated diabetes is cystic fibrosis-related diabetes (CFRD), in which pancreatic exocrine insufficiency pre-dates the pancreatic endocrine insufficiency responsible for the development of diabetes. Because diabetes in cystic fibrosis is associated with worse nutritional status, more severe inflammatory lung disease, and greater mortality from respiratory failure, CFRD has long been recognized as a distinct form of diabetes requiring a specified approach to evaluation and treatment (30) now recognized by the American Diabetes Association (28). While the distinct pathogenesis of diabetes in chronic pancreatitis has also long been appreciated, only recently have guidelines been developed supporting a specified diagnostic and therapeutic algorithm (37). Finally, other less common forms of pancreatogenic diabetes exist, such as that due to pancreatic cancer (18), as well as post-pancreatectomy diabetes, with each requiring individualized approaches to care. 2. Classification Pancreatogenic diabetes is classified by the American Diabetes Association and by the World Health Organization as type 3c diabetes mellitus (T3cDM) and refers to diabetes due to impairment in pancreatic endocrine function related to pancreatic exocrine damage due to acute, relapsing and chronic pancreatitis (of any etiology), cystic fibrosis, hemochromatosis, pancreatic cancer, and pancreatectomy, and as well rare causes such as neonatal diabetes due to pancreatic agenesis (1). Prevalence data on T3cDM are scarce b Continue reading >>

More in diabetes