Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms After Total Pancreatectomy.

Abstract:

OBJECTIVES:The aims of this study were to compare the safety, efficacy, and patients' quality of life with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDIs) in type 3c diabetes mellitus (T3cDM) following total pancreatectomy (TP) and pancreatic enzyme usage. METHODS:Thirty-nine patients with T3cDM (18 CSII patients vs 21 MDI patients) who underwent TP between 2000 and 2016 at 3 Harvard-affiliated hospitals and the University of Minnesota returned prospectively obtained questionnaires examining quality of life and both endocrine and exocrine pancreatic functions. RESULTS:Main indications for TP were as follows: chronic pancreatitis (n = 19), intraductal papillary mucinous neoplasm (n = 12), and adenocarcinoma (n = 4). Median hemoglobin A1c using MDIs was 8.1% versus 7.3% in CSII. Severe hypoglycemic events using MDIs were increased compared with CSII (P = 0.02). There were no significant differences in quality-of-life measures with CSII versus MDIs. Pancreatic enzyme dose per meal (P < 0.05) differed between the hospitals. Gastrointestinal symptoms and unintended weight loss (P < 0.01) were more common with low doses of pancreatic enzymes. CONCLUSIONS:After TP, CSII therapy is safe compared with MDIs in T3cDM and not associated with an increase in severe hypoglycemic events. Pancreatic enzyme replacement therapy is highly variable with low doses associated with unintentional weight loss and gastrointestinal symptoms.

journal_name

Pancreas

journal_title

Pancreas

authors

Struyvenberg MR,Fong ZV,Martin CR,Tseng JF,Clancy TE,Fernández-Del Castillo C,Tillman HJ,Bellin MD,Freedman SD

doi

10.1097/MPA.0000000000000917

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

1188-1195

issue

9

eissn

0885-3177

issn

1536-4828

pii

00006676-201710000-00015

journal_volume

46

pub_type

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