Diabetes Can Be Controlled in Patients After Pancreas Removal

A new study suggests that removing the entire pancreas in patients with cancer or precancerous cysts does not result in unmanageable diabetes.

Research at the Mayo Clinic (Jacksonville, FL, USA) conducted a retrospective study involving 14 patients who underwent total pancreatectomy (TP); Hemoglobin A1C (HbA1C) was measured at 6, 12, 18, and 24 months after TP. The researchers then compared their findings with 100 people with type 1 diabetes mellitus (DM) who need to use insulin replacement; baseline measurement in the control group was defined as 6 months prior to the first HbA1c measure.

They researchers found the mean HgbA1C at each point of interest was similar between the TP and type I DM patient cohort. Seven TP patients (50%) experienced a hypoglycemic event compared to 65 type 1 DM patients (65%). Both groups had little difficulty controlling their blood sugar, and no complications resulted. According to the researchers, the findings suggest that glycemic control following TP can be well managed. The study was published early online on August 26, 2012, in HPB Surgery.

"What we have shown here is that, due to wonderful recent improvements in insulin therapy, patients without a pancreas can control their blood sugar as effectively as type 1 diabetes patients can,” said senior investigator Michael Wallace, MD, chair of the division of gastroenterology and hepatology. “Most surgeons today make difficult decisions about how much of the pancreas to remove in a patient, but that process may become a little more straightforward now that we have demonstrated patients do well when their entire pancreas is removed.”

Even though the approach of preserving as much of the pancreas as possible benefits most patients, leaving part of the pancreas in others may put them at risk of developing hard-to-detect cancer in the remaining organ. Similarly, patients who have a potentially precancerous cystic condition known as intraductal papillary mucinous neoplasm in part of the pancreas can develop the same cysts in the part of the pancreas that remains after partial removal. Removing the entire pancreas eliminates the possibility of recurrence in the residual pancreas.

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