Cargando…

Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation

Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive. In this sing...

Descripción completa

Detalles Bibliográficos
Autores principales: Verma, Neha, Rajab, Amer, Buss, Jill, Lara, Luis, Porter, Kyle, Hart, Philip, Conwell, Darwin, Washburn, W. Kenneth, Black, Sylvester, Kuntz, Kristin, Meng, Shumei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772034/
https://www.ncbi.nlm.nih.gov/pubmed/33426086
http://dx.doi.org/10.1155/2020/9282310
_version_ 1783629792270090240
author Verma, Neha
Rajab, Amer
Buss, Jill
Lara, Luis
Porter, Kyle
Hart, Philip
Conwell, Darwin
Washburn, W. Kenneth
Black, Sylvester
Kuntz, Kristin
Meng, Shumei
author_facet Verma, Neha
Rajab, Amer
Buss, Jill
Lara, Luis
Porter, Kyle
Hart, Philip
Conwell, Darwin
Washburn, W. Kenneth
Black, Sylvester
Kuntz, Kristin
Meng, Shumei
author_sort Verma, Neha
collection PubMed
description Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield, and post-TPIAT glucose management data to further understand their relationship. Islet yield, glucose level, and insulin requirement for 72 hours postoperatively were collected for a total of 13 TPIAT recipients between 9-2013 and 9-2018. In addition, their glucose control and basal insulin requirements at 3, 6, and 12 months post-TPIAT were analyzed. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median postoperative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin, or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour postoperatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6, and 12 months showed a positive correlation. Despite the finding of inverse correlation of islet yield with long-term basal insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies. The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long-term insulin management following TPIAT. This observation may identify a high-risk group of patients in need of more intensive diabetes education and insulin treatment prior to hospital discharge.
format Online
Article
Text
id pubmed-7772034
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-77720342021-01-08 Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation Verma, Neha Rajab, Amer Buss, Jill Lara, Luis Porter, Kyle Hart, Philip Conwell, Darwin Washburn, W. Kenneth Black, Sylvester Kuntz, Kristin Meng, Shumei J Diabetes Res Research Article Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield, and post-TPIAT glucose management data to further understand their relationship. Islet yield, glucose level, and insulin requirement for 72 hours postoperatively were collected for a total of 13 TPIAT recipients between 9-2013 and 9-2018. In addition, their glucose control and basal insulin requirements at 3, 6, and 12 months post-TPIAT were analyzed. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median postoperative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin, or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour postoperatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6, and 12 months showed a positive correlation. Despite the finding of inverse correlation of islet yield with long-term basal insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies. The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long-term insulin management following TPIAT. This observation may identify a high-risk group of patients in need of more intensive diabetes education and insulin treatment prior to hospital discharge. Hindawi 2020-12-21 /pmc/articles/PMC7772034/ /pubmed/33426086 http://dx.doi.org/10.1155/2020/9282310 Text en Copyright © 2020 Neha Verma et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Verma, Neha
Rajab, Amer
Buss, Jill
Lara, Luis
Porter, Kyle
Hart, Philip
Conwell, Darwin
Washburn, W. Kenneth
Black, Sylvester
Kuntz, Kristin
Meng, Shumei
Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation
title Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation
title_full Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation
title_fullStr Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation
title_full_unstemmed Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation
title_short Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation
title_sort immediate postoperative insulin requirements may predict metabolic outcome after total pancreatectomy and islet autotransplantation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772034/
https://www.ncbi.nlm.nih.gov/pubmed/33426086
http://dx.doi.org/10.1155/2020/9282310
work_keys_str_mv AT vermaneha immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT rajabamer immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT bussjill immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT laraluis immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT porterkyle immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT hartphilip immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT conwelldarwin immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT washburnwkenneth immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT blacksylvester immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT kuntzkristin immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation
AT mengshumei immediatepostoperativeinsulinrequirementsmaypredictmetabolicoutcomeaftertotalpancreatectomyandisletautotransplantation