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Diabetes risk high after near-total pancreatectomy
The risk for developing diabetes is high among children with hyperinsulinism who undergo near-total pancreatectomy, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
Children with hyperinsulinism commonly have neurobehavioral deficits and developmental assessment is essential, according to the researchers.
“The management of congenital [hyperinsulinism] is challenging, particularly for those children who fail to respond to medical therapy,” the researchers wrote. “In order to avoid recurrent and severe hypoglycemia, pancreatectomy is often their only option. Although children with focal [hyperinsulinism] are cured with partial pancreatic resection, children with diffuse [hyperinsulinism] require near-total pancreatectomies, which place them at higher risk of diabetes.”
Diva D. DeLeón
Diva D. DeLeón, MD, of The Children’s Hospital of Philadelphia, and colleagues evaluated data from 121 patients (median age at enrollment, 8.9 years) who underwent pancreatectomy for hyperinsulinism between 1960 and 2008 to determine the prevalence of diabetes and neurobehavioral deficits among them. Patient interviews and medial record reviews were used to identify diabetes outcomes, and neurobehavioral outcomes were evaluated through the Adaptive Behavior Assessment System – Second Edition (ABAS-II) and the Child Behavior Checklist (CBCL).
Diabetes was present in 36% of patients, with nine developing the disease immediately after pancreatectomy. The median age at diabetes diagnosis of the remaining 35 patients was 7.7 years. Median HbA1c was 7.4% at the beginning of the study. Eighty-six percent of the patients with diabetes required insulin.
Compared with patients who did not develop diabetes, those who did had a greater median percent pancreatectomy (P < .0005).
Forty-eight percent of patients had neurobehavioral problems; psychiatric/behavioral problems and speech delay were the most common.
“The fact that children with focal [hyperinsulinism] who are cured after surgery, as well as children with transient [hyperinsulinism] in whom the hyperinsulinism resolves spontaneously, suffer from neurodevelopmental deficits, strongly suggests that the initial insult from recurrent hypoglycemia prior to diagnosis and treatment greatly contributes to the poor outcomes,” the researchers wrote. “Thus, early diagnosis and aggressive treatment of hypoglycemia is necessary to improve the long-term outcomes of children with hyperinsulinism. New guidelines published by the Pediatric Endocrine Society seek to improve the early identification of these children.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.