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Pancreatogenic Diabetes after Partial Pancreatectomy: A Common and Understudied Cause of Morbidity.

OBJECTIVE
The primary objective of this study is to determine the long-term incidence of pancreatogenic diabetes mellitus and its clinical impact following partial pancreatic resection.


SUMMARY BACKGROUND
Partial pancreatic resection is a known risk factor for new-onset pancreatogenic diabetes mellitus (P-DM). The long-term incidence of P-DM and its clinical impact following partial pancreatic resection remains unknown.


METHODS
The Medicare 100% Standard Analytic File (2013-2017) was queried for all patients who underwent partial pancreatic resection (pancreaticoduodenectomy, distal pancreatectomy). The primary outcome was the development of postoperative P-DM following surgery.


RESULTS
Among 4,255 patients who underwent a pancreaticoduodenectomy or distal pancreatectomy, with a median follow-up of 10.8 months, the incidence of P-DM was 20.3% (n=863) and occurred at a median of 3.6 months following surgery. For patients with at least a three-year follow-up, 32.2% of patients developed P-DM. Risk factors for developing P-DM included male gender (OR 1.32, 95%CI 1.13-1.54), undergoing a distal pancreatectomy (OR 1.98, 95%CI 1.68-2.35), having a malignant diagnosis (OR 1.65, 95%CI 1.34-2.04), a family history of diabetes (OR 2.06, 95%CI 1.43-2.97) (all p<0.001) and being classified as prediabetic in the preoperative setting (OR 1.57, 95%CI 1.18-2.08; P=0.002). Patients who developed P-DM were more commonly readmitted within 90 days of surgery and had higher postoperative healthcare expenditures in the year following surgery ($24,440 USD vs. $16,130 USD) (both p<0.001) versus patients without P-DM.


CONCLUSION
Approximately one in five Medicare beneficiaries who undergo a pancreatic resection develop pancreatogenic diabetes following pancreatic resection. Appropriate screening and improved patient education should be conducted for these patients, particularly for those with identified risk factors.