Resection type, pancreas volume tied to new‐onset T3cDM following partial pancreatectomy

Patients undergoing partial pancreatectomy may develop type 3c diabetes mellitus (T3cDM) after the procedure, with risk factors including type of resection, volume of pancreas resected and preoperative glycaemic control, a study reports.

Researchers conducted a systematic review of studies estimating the incidence of T3cDM in patients scheduled to have pancreatic resection either preoperatively or postoperatively. The meta-analysis included 36 articles, 34 of which were observational and two were case‐control, involving a total of 9,970 patients.

Of the patients, 5,636 were undergoing pancreaticoduodenectomy, 3,922 distal pancreatectomy and 315 central pancreatectomy. Median follow‐up ranged from 6 months to 8.9 years. The indication for pancreatic surgery included benign, borderline or malignant tumours, as well as chronic pancreatitis. Diabetes was diagnosed using the following methods: fasting plasma glucose, oral glucose tolerance test, HbA1c, or the use of oral hypoglycaemic agents or insulin. 

Pooled results revealed a significant difference in the incidence of new‐onset T3cDM between different types of resection: from 9 percent to 24 percent after pancreaticoduodenectomy (pooled estimate, 16 percent, 95 percent confidence interval [CI], 14–17), from 3 percent to 40 percent after distal pancreatectomy (pooled estimate, 21 percent, 95 percent CI, 16–25), and from 0 percent to 14 percent after central pancreatectomy (pooled estimate, 6 percent, 95 percent CI, 3–9).

Other factors significantly associated with new-onset T3cDM were surgical site, higher preoperative HbA1c, fasting plasma glucose and lower remnant pancreatic volume.

The researchers emphasized that patients with the said risk factors should undergo closer follow‐up. Additional studies are needed to support the development of management guidelines for this increasingly prevalent disorder.