835-P: A Unique Form of Pancreatogenic Diabetes—Experiences with the Treatment of Patients Who Underwent Pancreatectomy

Objective: Pancreatogenic diabetes (T3cDM) is most often caused by chronic pancreatitis, pancreatic cancer, hemochromatosis, cystic fibrosis, and most rarely by pancreas removal. It is often associated with T2DM, so several parallel pathological processes are behind hyperglycemia, in which case it cannot be clearly established to what extent each disease process (pancreatic disease, insulin resistance, T2DM, etc.) is involved in the development of hyperglycemia.

Methods: T3cDM in patients with total pancreatic resection is of purely pancreatogenic origin. Our working group created a register for patients who underwent pancreatic resections to optimize the treatment of this most fragile type of diabetes.

Results: So far, 49 (22M, 67 years) patients who did not have diabetes before pancreatectomy have been added to our database. The average total daily insulin requirement of the patients was 34 U (bolus: 23.3 U, basal:10.6 U). The imbalanced (68%) bolus requirement is explained by the fact that the daily carbohydrate intake often had to be increased to over 300 grams, even with massive pancreatic enzyme replacement. The most proven treatment was human fast-acting insulin given in addition to iGlar300 or degludec base. After six months, the average HbA1c value of the patients was 7.3%, and the average weight loss was 2.6 kg. Due to acute complications of diabetes, none of the patients was admitted to ER.

Conclusion: To our knowledge, our registry is the only database that collects and follows data of patients who underwent total pancreatectomy. Despite the unique challenges (insulin, glucagon, and digestive enzyme deficiency immediately after surgery, weight loss, gastric dissection), satisfactory metabolic control was achieved by educating the patients and their relatives. Our experiences with patients who underwent total pancreatectomy can benefit the care of T3cDM of another origin.