Article Text

Risk factors for new-onset diabetes mellitus after distal pancreatectomy
  1. Menghua Dai1,2,
  2. Cheng Xing1,2,
  3. Ning Shi3,
  4. Shunda Wang1,2,
  5. Guangdong Wu1,2,
  6. Quan Liao1,2,
  7. Taiping Zhang1,2,
  8. Ge Chen1,2,
  9. Wenming Wu1,2,
  10. Junchao Guo1,2,
  11. Ziwen Liu1,2
  1. 1Department of General Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
  2. 2National Translational Medicine of China, Beijing, China
  3. 3Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
  1. Correspondence to Dr Menghua Dai; daimh{at}pumch.cn

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.

  • general surgery
  • pancreas
  • risk factors
  • diabetes mellitus
  • type 2
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Statistics from Altmetric.com

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • MD, CX and NS contributed equally.

  • Contributors MD, CX, and NS analyzed the data, wrote and revised the manuscript. MD designed the study and supervised the whole project. CX, NS, SW, and GW collected, analyzed and discussed the data. MD, QL, TZ, GC, WW, JG and ZL performed the operations, supervised the project, analyzed and discussed the data, and revised the manuscript. All the authors approved to submit the final manuscript for publication consideration.

  • Funding This study was supported by the project of application and promotion of capital special clinical research from Beijing Municipal Science and Technology Commission (Z171100001017017018) and the Guangdong Medical Science and Technology Research Fund (A2018128).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the institutional review board and registered at the US National Institutes of Health (https://www.clinicaltrials.gov/).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data generated or used during the study are available from the corresponding author by request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.