Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy

Maarten R. Struyvenberg, Zhi Ven Fong, Camilia R. Martin, Jennifer F. Tseng, Thomas E. Clancy, Carlos Fernández-Del Castillo, Hanna J. Tillman, Melena D Bellin, Steven D. Freedman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives The aims of this study were to compare the safety, efficacy, and patients' quality of life with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDIs) in type 3c diabetes mellitus (T3cDM) following total pancreatectomy (TP) and pancreatic enzyme usage. Methods Thirty-nine patients with T3cDM (18 CSII patients vs 21 MDI patients) who underwent TP between 2000 and 2016 at 3 Harvard-affiliated hospitals and the University of Minnesota returned prospectively obtained questionnaires examining quality of life and both endocrine and exocrine pancreatic functions. Results Main indications for TP were as follows: chronic pancreatitis (n = 19), intraductal papillary mucinous neoplasm (n = 12), and adenocarcinoma (n = 4). Median hemoglobin A1c using MDIs was 8.1% versus 7.3% in CSII. Severe hypoglycemic events using MDIs were increased compared with CSII (P = 0.02). There were no significant differences in quality-of-life measures with CSII versus MDIs. Pancreatic enzyme dose per meal (P < 0.05) differed between the hospitals. Gastrointestinal symptoms and unintended weight loss (P < 0.01) were more common with low doses of pancreatic enzymes. Conclusions After TP, CSII therapy is safe compared with MDIs in T3cDM and not associated with an increase in severe hypoglycemic events. Pancreatic enzyme replacement therapy is highly variable with low doses associated with unintentional weight loss and gastrointestinal symptoms.

Original languageEnglish (US)
Pages (from-to)1188-1195
Number of pages8
JournalPancreas
Volume46
Issue number9
DOIs
StatePublished - Oct 1 2017

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Subcutaneous Infusions
Pancreatectomy
Insulin
Injections
Diabetes Mellitus
Quality of Life
Hypoglycemic Agents
Weight Loss
Enzymes
Therapeutics
Enzyme Replacement Therapy
Chronic Pancreatitis
Patient Safety
Meals
Hemoglobins
Adenocarcinoma
Neoplasms

Keywords

  • exocrine pancreatic insufficiency
  • gastrointestinal symptoms
  • insulin pump
  • pancreatectomy
  • pancreatic enzymes

Cite this

Struyvenberg, M. R., Fong, Z. V., Martin, C. R., Tseng, J. F., Clancy, T. E., Fernández-Del Castillo, C., ... Freedman, S. D. (2017). Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy. Pancreas, 46(9), 1188-1195. https://doi.org/10.1097/MPA.0000000000000917

Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy. / Struyvenberg, Maarten R.; Fong, Zhi Ven; Martin, Camilia R.; Tseng, Jennifer F.; Clancy, Thomas E.; Fernández-Del Castillo, Carlos; Tillman, Hanna J.; Bellin, Melena D; Freedman, Steven D.

In: Pancreas, Vol. 46, No. 9, 01.10.2017, p. 1188-1195.

Research output: Contribution to journalArticle

Struyvenberg, MR, Fong, ZV, Martin, CR, Tseng, JF, Clancy, TE, Fernández-Del Castillo, C, Tillman, HJ, Bellin, MD & Freedman, SD 2017, 'Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy', Pancreas, vol. 46, no. 9, pp. 1188-1195. https://doi.org/10.1097/MPA.0000000000000917
Struyvenberg MR, Fong ZV, Martin CR, Tseng JF, Clancy TE, Fernández-Del Castillo C et al. Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy. Pancreas. 2017 Oct 1;46(9):1188-1195. https://doi.org/10.1097/MPA.0000000000000917
Struyvenberg, Maarten R. ; Fong, Zhi Ven ; Martin, Camilia R. ; Tseng, Jennifer F. ; Clancy, Thomas E. ; Fernández-Del Castillo, Carlos ; Tillman, Hanna J. ; Bellin, Melena D ; Freedman, Steven D. / Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy. In: Pancreas. 2017 ; Vol. 46, No. 9. pp. 1188-1195.
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