Impact of Preoperative Diabetes on Insulin Management and Nutritional Status After Total or Completion Pancreatectomy

Abstract

Background: Insulin requirements after total or completion pancreatectomy (TP/CP) remain uncertain, complicating postoperative diabetes and nutritional care. This study uncovers key factors influencing these requirements.

Methods: This retrospective study included 53 patients who underwent TP/CP between July 2005 and October 2023. Data on the perioperative clinical, diabetic, and nutritional factors were also collected. Multivariable analyses were performed for the insulin-to-glucose ratio (IGR) on postoperative days (POD) 1 and 2 and the insulin dose during long-term follow-up.

Results: The median insulin dose and IGR on POD 1 and 2 were 47 units/day and 0.26 units/g, respectively. The median insulin dose at discharge was 18 U/day, which increased to 23 U/day during follow-up. High preoperative HbA1c levels (odds ratio [OR], 8.68) and long operation time (OR 7.26) were determinants of high IGR. Although long-standing diabetes mellitus before surgery did not correlate with IGR, it was the sole predictor of high insulin requirement (OR 8.09) during follow-up (30 vs. 20 units/day). This resulted in improved nutritional status, as reflected by changes in body weight (P < 0.001) and nutritional scores (CONUT score, P = 0.041; geriatric nutritional risk index, P = 0.002). In contrast, patients without preoperative diabetes tended to require low insulin doses during follow-up, leading to poor diabetic control and worsening of nutritional status, as reflected in the CONUT score (P = 0.013).

Conclusions: Adjusting insulin doses and controlling diabetes can be more challenging when performing TP/CP in patients without diabetes than in patients with long-standing diabetes mellitus. Careful management is required for these patients to achieve better nutritional status.

Keywords: Completion pancreatectomy; Diabetes mellites; Late complication; Long-standing DM; Total pancreatectomy.