Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan.
Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan.
J Clin Endocrinol Metab. 2022 Nov 25;107(12):3362-3369. doi: 10.1210/clinem/dgac529.
The glucose tolerance of patients changes considerably from before to after pancreaticoduodenectomy wherein approximately half of the pancreas is resected.
The aim of this prospective study was to investigate the incidence of and risk factors for diabetes after pancreaticoduodenectomy.
This study is a part of an ongoing prospective study, the Kindai Prospective Study on Metabolism and Endocrinology after Pancreatectomy (KIP-MEP) study. Of the 457 patients enrolled to date, 96 patients without diabetes who underwent pancreaticoduodenectomy were investigated in this study. Preoperatively, 1 month post-pancreaticoduodenectomy, and every 6 months thereafter, the glucose metabolism and endocrine function were evaluated using the 75 g oral glucose tolerance test. Various other metabolic, endocrine, and exocrine indices were also examined over a period of up to 36 months.
Of the 96 patients analyzed in this study, 33 were newly diagnosed with diabetes. The cumulative diabetes incidence at 36 months following pancreaticoduodenectomy was 53.8%. The preoperative insulinogenic index and ΔC-peptide in the glucagon stimulation test were significantly lower in the progressors to diabetes than in the nonprogressors. Multivariate Cox regression analysis demonstrated that the insulinogenic index was the only significant risk factor for new-onset diabetes.
The majority of patients developed new-onset diabetes after pancreaticoduodenectomy, and a low value of the insulinogenic index was suggested to be a risk factor for diabetes. Preoperative assessment for the prediction of the onset of diabetes serves as useful information for patients and is important for postoperative glycemic control and diabetes management in patients who require pancreaticoduodenectomy.
胰腺十二指肠切除术后患者的糖耐量会发生很大变化，因为此时大约有一半的胰腺被切除。
本前瞻性研究旨在调查胰腺十二指肠切除术后发生糖尿病的发病率和危险因素。
本研究是正在进行的前瞻性研究——金泽大学胰腺切除术后代谢和内分泌研究（KIP-MEP 研究）的一部分。迄今为止，已有 457 名患者入组，其中 96 名无糖尿病的胰腺十二指肠切除术患者被纳入本研究。术前、胰腺十二指肠切除术后 1 个月以及此后每 6 个月，通过 75g 口服葡萄糖耐量试验评估葡萄糖代谢和内分泌功能。在长达 36 个月的时间内，还检查了各种其他代谢、内分泌和外分泌指标。
本研究分析的 96 例患者中，有 33 例新诊断为糖尿病。胰腺十二指肠切除术后 36 个月的累积糖尿病发病率为 53.8%。糖尿病进展者的术前胰岛素原指数和胰高血糖素刺激试验中的ΔC 肽明显低于非进展者。多变量 Cox 回归分析表明，胰岛素原指数是新发糖尿病的唯一显著危险因素。
大多数患者在胰腺十二指肠切除术后出现新发糖尿病，胰岛素原指数降低提示糖尿病风险增加。术前评估有助于预测糖尿病的发生，为患者提供有用信息，对于需要胰腺十二指肠切除术的患者的术后血糖控制和糖尿病管理非常重要。
