Detailed Abstract
[E-poster - Biliary & Pancreas (Pancreas Disease/Surgery)]
[EP 071] Cardiovascular risk factors and intraoperative hypotension predicted development of insulin deficiency and diabetes after pancreatectomy
Seoil MOON1 , Jun Suh LEE2 , Heeju SOHN3 , Youngmin HAN3 , Hongbeom KIM3 , Wooil KWON3 , Yoo-Seok YOON2 , Ho-Seong HAN2 , Tae Jung OH4 , Kyong Soo PARK1 , Hak Chul JANG4 , Jin-Young JANG3 , Hye Seung JUNG*1
1 Internal Medicine, Seoul National University Hospital, REPUBLIC OF KOREA
2 Surgery, Seoul National University Bundang Hospital, REPUBLIC OF KOREA
3 Surgery, Seoul National University Hospital, REPUBLIC OF KOREA
4 Internal Medicine, Seoul National University Bundang Hospital, REPUBLIC OF KOREA
Background : Ischemia in pancreatic islets is critical to β-cell function, however, clinical evidences on the implications for diabetes are lacking. Pancreatectomy can induce diabetes, but the mechanisms are not clearly elucidated. Therefore, we examined if cardiovascular disease (CVD) risk factors and intraoperative ischemia, which could cause perfusion insufficiency in pancreatic islets, are associated with insulin deficiency and diabetes after pancreatectomy.
Methods : From 2 prospective cohorts of pancreatectomy since 2007, participants were enrolled who had pre-operative HbA1c < 7% without anti-diabetics. As for proximal pancreatectomy, those were selected whose HOMA-R increased after surgery. Insulin secretion was assessed by changes in HOMA-B for 1 year (ΔB). The participants were divided into low- and high-ΔB groups, with stratification by operation type, pre-operative HbA1c, HOMA-B, HOMA-R, and ΔR. Then CVD risk factors and intraoperative ischemic events were compared between the 2 groups, and evaluated for diabetes incidence. in
Results : A total of 237 patients were enrolled (men 44%, age 56 years, HbA1c 5.6% in average). Low-ΔB (median -32% of baseline) and high-ΔB (5%) groups showed comparable baseline metabolic variables. According to logistic regression analyses and Cox regression model, a composite of IGT, hypertension, dyslipidemia and a reduction in intraoperative systolic BP significantly decreased HOMA-B after 1 year (RR, 9.52; 95% CI, 1.14-79.3), and increased diabetes incidence (HR, 3.3; 95% CI, 1.2-8.9), after adjustment with age, sex, BMI, HbA1c and operation. a
Conclusions : We observed that chronic ischemia suggested by CVD risk factors and intraoperative ischemic insult were linked to development of insulin deficiency and diabetes after pancreatectomy. Funding: NRF (2019R1A2C1007397)
Methods : From 2 prospective cohorts of pancreatectomy since 2007, participants were enrolled who had pre-operative HbA1c < 7% without anti-diabetics. As for proximal pancreatectomy, those were selected whose HOMA-R increased after surgery. Insulin secretion was assessed by changes in HOMA-B for 1 year (ΔB). The participants were divided into low- and high-ΔB groups, with stratification by operation type, pre-operative HbA1c, HOMA-B, HOMA-R, and ΔR. Then CVD risk factors and intraoperative ischemic events were compared between the 2 groups, and evaluated for diabetes incidence. in
Results : A total of 237 patients were enrolled (men 44%, age 56 years, HbA1c 5.6% in average). Low-ΔB (median -32% of baseline) and high-ΔB (5%) groups showed comparable baseline metabolic variables. According to logistic regression analyses and Cox regression model, a composite of IGT, hypertension, dyslipidemia and a reduction in intraoperative systolic BP significantly decreased HOMA-B after 1 year (RR, 9.52; 95% CI, 1.14-79.3), and increased diabetes incidence (HR, 3.3; 95% CI, 1.2-8.9), after adjustment with age, sex, BMI, HbA1c and operation. a
Conclusions : We observed that chronic ischemia suggested by CVD risk factors and intraoperative ischemic insult were linked to development of insulin deficiency and diabetes after pancreatectomy. Funding: NRF (2019R1A2C1007397)
SESSION
E-poster
E-Session 03/03 ~ 03/05 ALL DAY