Hemoglobin A1c as a marker to stratify diabetes risk following pancreaticoduodenectomy

BACKGROUND: Pancreatic cancer has been shown to cause diabetes mellitus, and diabetes mellitus has been shown to be a risk factor for pancreatic cancer. The effect of pancreaticoduodenectomy on risk for development of diabetes mellitus is unclear. This study used hemoglobin A1c to determine the incidence of diabetes mellitus development following pancreaticoduodenectomy based on preoperative risk of diabetes mellitus. METHODS: Retrospective review of patients undergoing pancreaticoduodenectomy was performed with comparison of preoperative diabetes mellitus status and hemoglobin A1c with development of diabetes mellitus postoperatively. Risk ratios were calculated to determine the risk for diabetes mellitus development. RESULTS: Among 90 patients who met inclusion criteria, 26.7% developed new-onset or worsening diabetes mellitus following pancreaticoduodenectomy. Of those with hemoglobin A1c ≤ 5.6%, only 7.7% of patients developed diabetes mellitus. Patients at risk for diabetes mellitus preoperatively had 4.0 times greater risk for development of diabetes mellitus following pancreaticoduodenectomy. CONCLUSION: Hemoglobin A1c levels should be used to identify patients at risk for new-onset or worsening diabetes mellitus following pancreaticoduodenectomy.