Obesity is the major preoperative risk factor for diabetes following pancreatic surgery

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-825
Farah Hena Morgan*1, Bert Bieler2, Batool Razvi2, Krystal Hunter2 and Marc J Laufgraben3
1Cooper University Hospital, Cherry Hill, NJ, 2Cooper University Hospital, 3Cooper University Hospital, Camden, NJ
Introduction: While postoperative diabetes is a well-known consequence of pancreatic surgery, there is little data available regarding the ability to identify those patients at higher risk. We hypothesized that a combination of risk factors would be able to predict those patients more likely to develop diabetes following pancreatic surgery.

Methods: Data was collected after IRB approval on all patients who had pancreatic surgery between January 1, 2010 and July 31, 2011. Demographic data, fasting glucose, HbA1c, BMI, extent of surgery, surgical indication, nutrition, length of stay, complications and diabetic medications were recorded. Univariate and multivariate techniques were used to analyze individual variables. Patients were considered diabetic if they required insulin or other anti-diabetic medications at discharge.

Results: 120 subjects met inclusion criteria. Patients on insulin preoperatively were excluded. Data was available on 84 of the remaining patients.  Twenty-one of 84 patients (25%) required insulin while in the hospital. Of these, seventeen patients were discharged on insulin and 4 patients were discharged on other anti-diabetic agents. Patients discharged on any anti-diabetic agent were more likely to have received enteral tube feeding or parenteral nutrition (P<0.01), to have a length of stay > 10 days (P<0.01) or to have an infection during their hospital stay (P 0.04). Higher BMI on admission (30.29 in the diabetic group vs. 26.33 in the non-diabetic group, P 0.01) was also associated with an increased risk of postoperative diabetes. Obese (BMI > 30) patients had 5.39 fold increased odds of having postoperative diabetes compared to normal and underweight individuals (P <0.01), and 3.99 fold increased odds of being discharged home on insulin (P 0.03). Using multivariate analysis, for every unit increase in BMI above 17.6, there was an 11% increased odds of diabetes at discharge. Similarly, for every additional day in the hospital above 5, there was a 3% increased odds of diabetes at discharge.

Conclusion: Obesity is an easily identifiable preoperative risk factor for diabetes following pancreatic surgery. BMI should be assessed in every patient planned for pancreatic surgery, and patients with BMI > 30 should be counseled on their increased risk for the development of postoperative diabetes. Length of stay > 10 days, infection, and the use of enteral tube feeding or parenteral nutrition are the major risk factors in the postoperative period.

Nothing to Disclose: FHM, BB, BR, KH, MJL

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm