Risk factors for new-onset diabetes mellitus after distal pancreatectomy

Menghua Dai, Cheng Xing, Ning Shi, Shunda Wang, Guangdong Wu, Quan Liao, Taiping Zhang, Ge Chen, Wenming Wu, Junchao Guo, Ziwen Liu, Menghua Dai, Cheng Xing, Ning Shi, Shunda Wang, Guangdong Wu, Quan Liao, Taiping Zhang, Ge Chen, Wenming Wu, Junchao Guo, Ziwen Liu

Abstract

Introduction: Several previous studies have reported the incidence of new-onset diabetes mellitus (NODM) after pancreatectomy. Nevertheless, the results were inconsistent. The true rate of NODM after distal pancreatectomy (DP) is still unknown.

Research design and methods: The aim of this study was to investigate the incidence of and the risk factors for NODM after DP. This study enrolled patients who underwent DP between January 2004 and February 2016 at Peking Union Medical College Hospital. Patients with preoperative diabetes mellitus or diagnosed with pancreatic cancer were excluded. The primary outcome was NODM.

Results: A total of 485 patients were enrolled. The median (IQR) of follow-up duration was 30.95 (9.26-180.30) months. The accumulative incidence of NODM was 8.9% at postoperative 6 months, 14.0% at postoperative year one, 22.3% at year three, 27.1% at year five, and 35.5% at year ten. Multivariate analysis showed that the risk of postoperative NODM was positively correlated with age (HR 1.029 (1.013-1.045), p<0.001), preoperative body mass index (BMI) (HR 1.042 (1.003-1.083), p=0.001), operative blood loss (HR 1.0003 (1.0002-1.0010), p<0.001), and length of resected pancreas (HR 1.079 (1.013-1.148), p=0.017). Moreover, concomitant splenectomy (HR 2.001 (1.202-3.331), p=0.008) was associated with significantly higher risk of postoperative NODM.

Conclusion: NODM incidence increased with postoperative time progression. Age, BMI, surgical blood loss, length of resected pancreas and splenectomy were independent risk factors for NODM after DP.

Trial registration number: NCT03030209.

Keywords: diabetes mellitus; general surgery; pancreas; risk factors; type 2.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of patient enrollment (A); the incidence of new-onset diabetes mellitus (NODM) increased with postoperative time progressing after distal pancreatectomy (DP) (B).
Figure 2
Figure 2
The incidences of new-onset diabetes mellitus (NODM) were significantly different between two comparative groups divided by the independent risk factors: age (A), preoperative BMI (B), length of resected pancreas (C), surgical blood loss (D), and splenectomy (E). The incidences of NODM were significantly different between patients with and without splenic infarction (F). BMI, body mass index.

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