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Blood Glucose Homeostasis in the Course of Partial Pancreatectomy--Evidence for Surgically Reversible Diabetes Induced by Cholestasis

Ehehalt, Florian ; Sturm, Dorothée ; Rösler, Manuela ; Distler, Marius ; Weitz, Jürgen ; Kersting, Stephan ; Ludwig, Barbara ; Schwanebeck, Uta ; Saeger, Hans-Detlev ; Solimena, Michele ; Grützmann, Robert Bruns, Helge

PloS one, 2015-08, Vol.10 (8), p.e0134140-e0134140 [Periódico revisado por pares]

United States: Public Library of Science

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Título:
Blood Glucose Homeostasis in the Course of Partial Pancreatectomy--Evidence for Surgically Reversible Diabetes Induced by Cholestasis
Autor: Ehehalt, Florian ; Sturm, Dorothée ; Rösler, Manuela ; Distler, Marius ; Weitz, Jürgen ; Kersting, Stephan ; Ludwig, Barbara ; Schwanebeck, Uta ; Saeger, Hans-Detlev ; Solimena, Michele ; Grützmann, Robert
Bruns, Helge
Assuntos: Adult ; Aged ; Antigens, Tumor-Associated, Carbohydrate - blood ; Bile ducts ; Blood ; Blood glucose ; Blood Glucose - analysis ; Body Mass Index ; Cholestasis ; Cholestasis - complications ; Cholestasis - pathology ; Complications and side effects ; Compression ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - metabolism ; Diabetes Mellitus, Type 2 - pathology ; Diabetes Mellitus, Type 2 - surgery ; Enzymes ; Family medical history ; Fasting ; Female ; Gastroenterology ; Gastrointestinal surgery ; Genetic aspects ; Glucose ; Glucose - metabolism ; Glucose tolerance ; Glucose Tolerance Test ; Glycated Hemoglobin A - analysis ; Hepatocytes ; Homeostasis ; Hospitals ; Humans ; Hypotheses ; Insulin ; Insulin - blood ; Insulin Resistance ; Insulin secretion ; Jaundice, Obstructive ; Laboratory testing ; Liver ; Male ; Markers ; Medicine ; Metabolic syndrome ; Metabolism ; Middle Aged ; Pancreas ; Pancreas - metabolism ; Pancreatectomy ; Pancreatic cancer ; Pancreatitis ; Pancreatitis, Chronic - metabolism ; Pancreatitis, Chronic - pathology ; Pancreatitis, Chronic - surgery ; Peptides ; Physiological aspects ; Secretion ; Studies ; Surgery ; Tumor markers ; Tumors ; Vascular surgery
É parte de: PloS one, 2015-08, Vol.10 (8), p.e0134140-e0134140
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Conceived and designed the experiments: FE SK BL HDS MS RG. Performed the experiments: FE DS MR MD JW SK HDS RG MS. Analyzed the data: FE SK US MS RG. Contributed reagents/materials/analysis tools: FE MD JW SK HDS MS RG. Wrote the paper: FE BL MS RG.
Competing Interests: The authors have declared that no competing interests exist.
Descrição: Partial pancreatic resection is accompanied not only by a reduction in the islet cell mass but also by a variety of other factors that are likely to interfere with glucose metabolism. The aim of this work was to characterize the patient dynamics of blood glucose homeostasis during the course of partial pancreatic resection and to specify the associated clinico-pathological variables. In total, 84 individuals undergoing elective partial pancreatic resection were consecutively recruited into this observational trial. The individuals were assigned based on their fasting glucose or oral glucose tolerance testing results into one of the following groups: (I) deteriorated, (II) stable or (III) improved glucose homeostasis three months after surgery. Co-variables associated with blood glucose dynamics were identified. Of the 84 participants, 25 (30%) displayed a normal oGTT, 17 (20%) showed impaired glucose tolerance, and 10 (12%) exhibited pathological glucose tolerance. Elevated fasting glucose was present in 32 (38%) individuals before partial pancreatic resection. Three months after partial pancreatic resection, 14 (17%) patients deteriorated, 16 (19%) improved, and 54 (64%) retained stable glucose homeostasis. Stability and improvement was associated with tumor resection and postoperative normalization of recently diagnosed glucose dysregulation, preoperatively elevated tumor markers and markers for common bile duct obstruction, acute pancreatitis and liver cell damage. Improvement was linked to preoperatively elevated insulin resistance, which normalized after resection and was accompanied by a decrease in fasting- and glucose-stimulated insulin secretion. Surgically reversible blood glucose dysregulation diagnosed concomitantly with a (peri-) pancreatic tumor appears secondary to compromised liver function due to tumor compression of the common bile duct and the subsequent increase in insulin resistance. It can be categorized as "cholestasis-induced diabetes" and thereby distinguished from other forms of hyperglycemic disorders.
Editor: United States: Public Library of Science
Idioma: Inglês

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Blood Glucose Homeostasis in the Course of Partial Pancreatectomy--Evidence for Surgically Reversible Diabetes Induced by Cholestasis

Ehehalt, Florian ; Sturm, Dorothée ; Rösler, Manuela ; Distler, Marius ; Weitz, Jürgen ; Kersting, Stephan ; Ludwig, Barbara ; Schwanebeck, Uta ; Saeger, Hans-Detlev ; Solimena, Michele ; Grützmann, Robert Bruns, Helge

United States: Public Library of Science

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