Study Characterizes New Onset Diabetes Risk Following Partial Pancreatic Resection

Stephen Firkins, MD

Findings from a new national study showed that risk of new onset diabetes mellitus following partial pancreatectomy for pancreatic cystic lesions (PCL) was associated with metabolic syndrome, increasing age, and cardiovascular disease/heart failure.

In a study presented at the annual American College of Gastroenterology (ACG) 2020 meeting, a team led by Stephen Firkins, MD of The Ohio State University Wexner Medical Center, characterized the incidence and risk factors associated with new onset diabetes in this patient population.

“Compared with patients who undergo surgery for other indications, including acute and chronic pancreatitis and pancreatic adenocarcinoma, patients with pancreatic cystic lesions (PCLs) generally have normal adjacent pancreatic parenchyma,” Firkins and colleagues wrote.

“However, the risk of post-operative diabetes mellitus among patients with PCLs is poorly defined,” they noted.

Therefore, they utilized the Truven Marketscan Research Database in order to identify adult patients with PCLs and without prevalent diabetes who had undergone a pancreatic resection.

They excluded patients with additional conditions, such as cystic fibrosis, hemochromatosis, acute pancreatitis within 6 months prior to surgery, prior chronic pancreatitis, and prior pancreatic cancer.

In order to identify incidence and risk factors, the investigators conducted a time to event analysis using Kaplan-Meier curves as well as multivariable Cox proportional hazards analysis.

Thus, among a total of 311 patients with PCLs, the overall risk of post-operative diabetes mellitus at 6 months was 9.1% (95% CI, 6.3-12.9). Risk at 1 year was 15.1% (95% CI, 11.3-20.2), and at 2 years was 20.2% (95% CI, 15.3-26.4).

Independent predictors of new onset diabetes were older age (55-64 years [HR, 1.97; 95% CI, 1.04-3.72] versus 18-54), obesity (HR, 2.63; 95% CI, 1.35-5.12), hypertension (HR, 1.79; 95% CI, 1.01-3.17), and cardiovascular disease/heart failure (HR, 2.54; 95% CI, 1.02-6.28).

Additionally, patients who had undergone distal pancreatectomy had no difference in risk for new onset diabetes mellitus than those who had pancreaticoduodenectomy (HR, 1.41; 95% CI, 0.69-2.88).

“In a large population-based cohort, the risk of new onset diabetes mellitus following pancreatectomy for PCL was not excessive, and was relatively higher in older patients with features of metabolic syndrome and/or cardiovascular disease,” Firkins and his team concluded.

“Individuals with these clinical characteristics may benefit from peri- and post-operative monitoring, education, and treatment strategies for DM,” they wrote.

They further suggested that effective and durable endoscopic treatments of PCLs, such as chemoablation, are therapies that can provide a parenchymal-sparing alternative to resection in high-risk patients.

The study, “Incidence and Predictors of New Onset Diabetes Mellitus Following Surgical Resection of Pancreatic Cystic Lesions,” was published online by ACG.