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Normal preoperative glucose may predict insulin independence after total pancreatectomy
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Insulin independence after total pancreatectomy with islet autotransplantation may be predicted by normal preoperative glucose status and lower fasting and post-challenge oral glucose tolerance test values, study data show.
Rita Rastogi Kalyani, MD, MHS, of the division of endocrinology, diabetes and metabolism at Johns Hopkins University School of Medicine, and colleagues evaluated 34 adults (mean age, 39.3 years) without diabetes who underwent total pancreatectomy with islet autotransplantation between 2011 and 2016 to determine glycemic predictors of insulin independence 1 year after surgery. All participants underwent a 75-g OGTT before surgery.
After 1 year, 10 participants were insulin independent. Mean HbA1c was lower in the insulin-independent group (5.5%) compared with the insulin-dependent group (8%).
Mean glucose levels were higher among the insulin-dependent group compared with the insulin-independent group at 0 minutes (94 mg/dL vs. 82 mg/dL; P = .02), 60 minutes (161 mg/dL vs. 109 mg/dL; P = .01) and 120 minutes (122 mg/dL vs. 96 mg/dL; P = .06).
A significant predictor of 1-year insulin independence was normal preoperative glycemic status in the unadjusted model (P = .01) and the age-adjusted model (P = .02). After adjustment for age, additional predictors of insulin independence were fasting glucose of 90 mg/dL or lower (P = .04), 1-hour OGTT 143 mg/dL or lower (P = .04) and 2-hour OGTT glucose 106 mg/dL or lower (P = .02).
Homeostasis model of assessment for beta-cell function had the highest area under the curve (AUC) for being a predictor of insulin independence (0.88; P < .01), followed by islet yield (AUC = 0.77; P < .01) in the receiver-operative curve analysis.
“All patients with prediabetes preoperatively, when defined as [impaired fasting glucose] and/or [impaired glucose tolerance], had insulin dependence at 1 year, with many patients being identified solely on the basis of having [IGT] — a novel finding,” the researchers wrote. “To date, islet yield has been the only consistent predictor of insulin independence reported in other studies but can only be ascertained during transplantation. Preoperative glycemic predictors offer the promise to identify those most likely to have insulin independence long term. Though further studies are needed, our results support the potential utility of OGTT in presurgical evaluation as a low-cost and potentially very useful preoperative diagnostic assessment to improve selection and counseling of [total pancreatectomy with islet autotransplantation] candidates regarding postoperative insulin independence.” – by Amber Cox
Disclosure: Kalyani reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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