Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Endocrinol (Lausanne). 2023 Feb 13;14:1097139. doi: 10.3389/fendo.2023.1097139. eCollection 2023.
Total pancreatectomy (TP) has been increasingly performed in recent years. However, studies on diabetes management after TP during different postoperative periods are still limited.
This study aimed to evaluate the glycemic control and insulin therapy of patients undergoing TP during the perioperative and long-term follow-up period.
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.
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 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, < 0.001) and basal insulin percentage (39.4 ± 16.5 vs 43.9 ± 9.9%, = 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.
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.
近年来，全胰切除术（TP）的应用日益增多。然而，关于不同术后时期 TP 后糖尿病管理的研究仍然有限。
本研究旨在评估接受 TP 的患者在围手术期和长期随访期间的血糖控制和胰岛素治疗情况。
本研究纳入了 93 例在中国某单一中心接受弥漫性胰腺肿瘤 TP 的患者。根据术前血糖状况，患者分为三组：非糖尿病组（NDG，n=41）、短期糖尿病组（SDG，术前糖尿病病程≤12 个月，n=22）和长期糖尿病组（LDG，术前糖尿病病程>12 个月，n=30）。评估围手术期和长期随访数据，包括生存率、血糖控制和胰岛素方案，并与完全胰岛素缺乏 1 型糖尿病（T1DM）进行比较分析。
TP 后住院期间，血糖值在目标范围内（4.4-10.0mmol/L）的占总数据的 43.3%，45.2%的患者发生低血糖事件。患者在接受肠外营养时接受持续静脉胰岛素输注，剂量为 1.20±0.47 单位/千克/天。在长期随访期间，TP 患者的糖化血红蛋白 A1 水平为 7.43±0.76%，通过连续血糖监测评估的血糖达标时间和变异系数与 T1DM 患者相似。然而，TP 后患者的每日胰岛素剂量（0.49±0.19 比 0.65±0.19 单位/千克/天，<0.001）和基础胰岛素比例（39.4±16.5%比 43.9±9.9%，=0.035）低于 T1DM 患者，使用胰岛素泵治疗的患者也是如此。无论是围手术期还是长期随访期间，LDG 患者的每日胰岛素剂量均显著高于 NDG 和 SDG 患者。
TP 患者的胰岛素剂量随术后时期而变化。在长期随访期间，TP 后的血糖控制和变异性与完全胰岛素缺乏的 T1DM 相当，但胰岛素需求较少。术前血糖状况应进行评估，因为它可以指导 TP 后的胰岛素治疗。
