Comparison of insulin demand and glucose homeostasis in patients after total and partial pancreatectomy to patients with type 1 and type 2 diabetes mellitus

Introduction In severe pancreatic diseases, pancreatic surgery and total pancreatectomy may be necessary. However, in complications of chronic pancreatitis but also in selected pancreatic tumors, a partial resection may be more appropriate. While in the latter less severe consequences for glucose control may be expected, the setting of a total pancreatectomy inevitably requires insulin therapy. The objective of the present study is to compare insulin regimens after total and partial pancreatectomy with those in type 1 diabetes (T1DM) and type 2 diabetes (T2DM). Materials and methods We analyzed pre- and postoperative data of patients that underwent pancreatic surgery in a high volume pancreas center. Data were compared with a cohort of patients with T1DM and T2DM that required insulin therapy and did not undergo pancreatic surgery. Additionally, we researched literature databases using the terms "pancreatogenic diabetes", "type 3c diabetes" and "pancreatectomy diabetes". Results Data of 32 (68.8 % women) patients that underwent total pancreatectomy and 41 (43.9 % women) patients who underwent partial pancreatectomy were analyzed. 56.3 % in the total pancreatectomy group had diabetes before surgery. After total pancreatectomy, all patients required insulin and were treated with an intensified insulin therapy. Compared with T1DM, insulin dosage was significantly lower (p < 0.0001). Doses of basal and prandial insulin were affected likewise. A new onset of diabetes was significantly less frequent after a partial pancreatectomy and insulin treatment was less often required. Discussion After total and partial pancreatectomy, lower basal and prandial insulin doses are required than in T1DM or T2DM. These results may help to estimate insulin requirements after pancreatectomy.