Insulinbedarf und Glukosehomöostase bei Menschen nach partieller und totaler Pankreatektomie im Vergleich zu Menschen mit anderen Diabetesformen

Zusammenfassung

Einleitung Pankreasresektionen werden bei schwerwiegenden Pankreaserkrankungen durchgeführt. Bei Komplikationen einer chronischen Pankreatitis, teilweise jedoch auch bei Raumforderungen, kann eine Pankreasteilresektion sinnvoll sein. Eine totale Pankreatektomie führt zum absoluten Insulinmangel und der Notwendigkeit einer Insulintherapie. Bei Teilresektionen (partielle Pankreatektomie) werden weniger gravierende Konsequenzen für den Glukosemetabolismus erwartet. Es ist das Ziel der vorliegenden Arbeit, die Insulinregime nach Pankreatektomie mit denen anderer Diabetesformen zu vergleichen.

Material und Methodik Es wurden Patientencharakteristika und Details der postoperativen Insulintherapie von pankreasoperierten Patienten einer spezialisierten Universitätsklinik für Viszeralchirurgie ausgewertet. Diese Daten wurden mit Kohorten nicht operierter Patienten mit Typ-1-Diabetes (T1DM; absoluter Insulinmangel) bzw. Typ-2-Diabetes (T2DM; Insulinresistenz und relativer Insulinmangel), jeweils unter Insulintherapie, verglichen. Ergänzt wurde diese Datenanalyse durch eine Literaturrecherche zu den Stichworten „pancreatogenic diabetes“, „type 3c diabetes“ und „pancreatectomy diabetes“.

Ergebnisse Daten von 32 (68,8 % Frauenanteil) bzw. 41 (43,9 % Frauenanteil) Patienten nach totaler bzw. partieller Pankreatektomie wurden analysiert. Vor der totalen Pankreatektomie hatten 56,3 % der Patienten einen Diabetes mellitus, postoperativ bestand bei allen Patienten eine Insulinpflichtigkeit. Dabei waren die Insulindosierungen im Vergleich mit Patienten mit T1DM (unter intensivierter Insulintherapie) signifikant niedriger (p < 0,0001). Die Dosierungen von Basal- (48,6 % weniger) und Mahlzeiteninsulin (38,1 % weniger) waren gleichermaßen betroffen. Eine partielle Pankreatektomie führte deutlich seltener zu einem Diabetes mellitus, und eine Insulintherapie war nur bei 26,8 % der Patienten erforderlich.

Diskussion Der basale und prandiale Insulinbedarf nach Pankreatektomie ist niedriger als bei einem T1DM und einem T2DM. Dies sollte bei der Blutzuckereinstellung nach Pankreatektomie berücksichtigt werden.

Abstract

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.

Schlüsselwörter

Pankreatektomie - pankreatogener Diabetes mellitus - Diabetes mellitus Typ 1 - Diabetes mellitus Typ 2 - Diabetes mellitus Typ 3c

Key words

pancreatectomy - pancreatogenic diabetes mellitus - type 1 diabetes mellitus - type 2 diabetes mellitus - type 3c diabetes mellitus

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