Favorable glycemic response after pancreatoduodenectomy in both patients with pancreatic cancer and patients with non-pancreatic canceropen access
- Authors
- Sohn, Seo Young; Lee, E.K.; Han, S.-S.; Lee, Y.J.; Hwangbo, Y.; Kang, Y.H.; Lee, S.D.; Kim, S.H.; Woo, S.M.; Lee, W.J.; Hong, E.K.; Park, S.-J
- Issue Date
- May-2018
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- diabetes mellitus; glucose metabolism; pancreatic cancer; pancreatoduodenectomy; periampullary cancer
- Citation
- MEDICINE, v.97, no.18, pp.1 - 6
- Indexed
- SCIE
SCOPUS
- Journal Title
- MEDICINE
- Volume
- 97
- Number
- 18
- Start Page
- 1
- End Page
- 6
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/150046
- DOI
- 10.1097/MD.0000000000010590
- ISSN
- 0025-7974
- Abstract
- Diabetes mellitus (DM) is prevalent in patients with pancreatic cancer and tends to improve after tumor resection. However, the glycemic response of non-pancreatic cancer patients after surgery has not been examined in detail. We aimed to investigate the changes in glucose metabolism in patients with pancreatic cancer or non-pancreatic cancer after pancreatoduodenectomy (PD).
We prospectively enrolled 48 patients with pancreatic cancer and 56 patients with non-pancreatic cancer, who underwent PD. Glucose metabolism was assessed with fasting glucose, glycated hemoglobin (HbA1c), plasma C-peptide and insulin, quantitative insulin check index (QUICKI), and a homeostatic model assessment of insulin resistance (HOMA-IR) and β cell (HOMA-β) before surgery and 6 months after surgery. Patients were divided into 2 groups: “improved” and “worsened” postoperative glycemic response, according to the changes in HbA1c and anti-diabetic medication. New-onset DM was defined as diagnosis of DM ≤ 2 years before PD, and cases with DM diagnosis >2 years preceding PD were described as long-standing DM.
After PD, insulin resistance (IR), as measured by insulin, HOMA-IR and QUICKI, improved significantly, although C-peptide and HOMA-β decreased. At 6 months after PD, new-onset DM patients showed improved glycemic control in both pancreatic cancer patients (75%) and non-pancreatic cancer patients (63%). Multivariate analysis showed that long-standing DM was a significant predictor for worsening glucose control (odds ratio = 4.01, P = .017).
Favorable glycemic control was frequently observed in both pancreatic cancer and non-pancreatic cancer after PD. PD seems to contribute improved glucose control through the decreased IR. New-onset DM showed better glycemic control than long-standing DM.
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