Long Term Glycemic Control is Similar Between Type 1 DM Patients and Patients Post Total Pancreatectomy for Intraductal Papillary Mucinous Neoplasm (IPMN): 232

Purpose: Diabetes Mellitus (DM) induced by total pancreatectomy (TP) is often thought to be difficult to manage, and could adversely influence the decision to perform the procedure, which is otherwise the treatment of choice in patients with main duct or multifocal IPMN. It is unclear if this has changed with recent advances in therapies for DM, and if underlying pancreatic disease affects glycemic control after TP. Only one French study of 10 patients found that glycemic control can be achieved successfully after TP for mucinous pancreatic tumors, but they did not compare them to a control group. Methods: Retrospective chart review of patients who have undergone TP for IPMN in our institution, to evaluate their glycemic control and compare long term glycemic control, via HbA1c, to a control group of 100 patients with Type 1 DM. Patients were included if they had at least one HbA1c measure at any of the 4 time points of interest (6, 12, 18, and 24 months). Type I DM patients were included if at baseline, their duration of disease was at least 2 years. Results: We identified 29 patients 14 of whom met inclusion criteria (2M, 14F), and 100 type 1 DM patients managed during the same time frame. Mean age for IPMN vs. DM was 70 vs. 50 (p<0.001), and no significant difference in BMI at baseline. All patients were started on Insulin drip post surgery and were discharged on insulin sliding scale for meal coverage in addition to Glargine insulin (10 patients), Insulin pump (3 patients), and Insulin Detemir (1 patient). Patients were also discharged on pancreatic enzyme supplements. One patient died 5 months after the surgery due to complications related to malnutrition. Hypoglycemic episodes were noted in 6 (43%) TP patients compared to 65 (65%) type I DM patients (P=0.14). All 6 (100%) TP patients who experienced a hypoglycemic episode treated the episode themselves, compared to 59 (91%) of type I DM patients, with the remaining 6 (9%) type I diabetes patients getting treatment at a hospital. Table 1 shows HbA1c values after baseline. There is no significant difference in HbA1C between the two groups at different time frames.Table: Table. HbA1c values after baseConclusion: DM induced by TP for IPMN can be well managed and controlled with a variety of insulin therapy regimens, with comparable HbA1c levels to patients with Type 1 DM. Fear of DM following TP for IPMN should not preclude surgery when indicated.