Glycemic control after total pancreatectomy for intraductal papillary mucinous neoplasm: An exploratory study

Background. Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN) is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C) at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5 versus 7.7, P = 0.52), 12 months (7.3 versus 8.0, P = 0.081), 18 months (7.7 and 7.6, P = 0.64), and at 24 months (7.3 versus 7.8, P = 0.10)). Seven TP patients (50) experienced a hypoglycemic event compared to 65 type 1 DM patients (65, P = 0.38). Limitations. Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.