Patients who undergo total pancreatectomy (TP) as a treatment for cancer or precancerous cysts in the pancreas may be able to achieve glycemic control similar to that seen in persons with type 1 diabetes who use insulin replacement, a small study indicates.
TP is the best treatment for diffuse intraductal papillary mucinous neoplasm (IPMN), a potentially precancerous and potentially curable cystic condition that can be a precursor to pancreatic adenocarcinoma, noted Michael B. Wallace, MD, chair of the Division of Gastroenterology and Hepatology at the Mayo Clinic in Jacksonville, Florida, and colleagues in HPB Surgery. However, glycemic control following TP has been thought to be difficult to manage.
Wallace’s team sought to compare glycemic control in persons undergoing TP for IPMN with glycemic control in persons with type 1 diabetes mellitus by retrospectively evaluating hemoglobin A1c (HbA1c) levels. Mean HbA1c at 6, 12, 18, and 24 months post-TP was similar between 14 persons who had had the surgery and 100 control patients with type 1 diabetes. (In the latter group, baseline was defined as 6 months prior to the first HbA1c measure.)
Specifically, mean HbA1c readings were as follows:
- 6-month measures: 7.5% for TP group vs 7.7% for diabetes group
- 12-month measures: 7.3% for TP group vs 8.0% for diabetes group
- 18-month measures: 7.7% for TP group vs 7.6% for diabetes group
- 24-month measures: 7.3% for TP group vs 7.8% for diabetes group.
Seven (50%) of the patients who underwent TP experienced a hypoglycemic event compared with 65 (65%) of the members of the diabetes group.
Despite the retrospective design of the study, small sample size, and lack of long-term follow-up, the investigators concluded that fear of post-TP diabetes should not be used to rule out TP when such surgery is a treatment option.