Abstract
Background:
Glycemic control has been studied in hospitalized patients with type 1 diabetes (T1D) or type 2 diabetes (T2D) and more recently type 3C diabetes who had total pancreatectomy (TP) and islet autotransplantation (IAT). To our knowledge, we report the first study using continuous glucose monitoring (CGM) to assess glucose control in TP without IAT during hospitalization.
Methods:
We completed blinded CGM (Dexcom G6 PRO) studies in 27 subjects in a nonintensive care unit setting who had TP at Mayo Clinic, Rochester, and compared two cohorts (CGM data < 30 days of TP [cohort 1] vs. ≥ 30 days of TP [cohort 2]). CGM glucose metrics were calculated as per American Diabetes Association guidelines for hospitalized patients with diabetes mellitus. CGM values were compared with point-of-care testing glucose within 5 min.
Results:
The baseline characteristics were not significantly different between the cohorts Table 1. The average TIGHT range (140 mg/dL–180 mg/dL) on day 1 was 13 ± 12.0 % in cohort 1 and 17.4 ± 27.7 % in cohort 2 without any statistically significant difference, while average TIGHT percentage on days 2–10 was 23.4% ± 25.8% and 20.6% ± 25.7% in cohort 1 and cohort 2, respectively (no statistically significant difference). Both cohorts spent the majority of (>50%) time above target range on day 1 and days 2–10. There were no significant differences in CGM metrics between the two cohorts. Overall, mean absolute relative difference was 19.6% ± 10, and number of readings meeting % 20/20, was 68% with least accuracy on day 1 of sensor insertion. There were no device-related adverse events.
Demographics and Baseline Characteristics in Patients with Total Pancreatectomy Acute cholangitis-1 Intestinal obstruction-2 Intestinal perforation-1 Sepsis-1 Metastatic pancreatic cancer involving liver-1 Acute posthemorrhagic anemia-1 Peritonitis-1 Mean ± standard deviation. Significant P value < 0.05. T1D, type 1 diabetes; T2D, type 2 diabetes; TP, total pancreatectomy; IPMN, intraductal papillary mucinous neoplasm; NET, neuroendocrine tumor.
Cohort 1
Cohort 2
P value
<30 days of total pancreatectomy (N = 19)
≥30 days of total pancreatectomy (N = 8)
Age (years)
58.04 ± 10.5
a
63.75 ± 5.9
a
0.6
Gender (M/F)
9/10
4/4
0.4
BMI
27.3 ± 5.8
a
22.9 ± 4.2
a
0.09
Ethnicity
0.3
Caucasian
14
07
African American
02
01
Hispanic
01
00
South American
01
00
Asian
01
00
Preexisting diabetes, T1D or T2D (Yes/No)
5/14
5/3
0.19
Duration of preexisting diabetes b/f TP
4.7 ± 4.9
a
10.5 ± 11.8
a
0.2
History of pancreatic tumor
0.2
Pancreatic cancer
16
08
IPMN
01
00
NET
02
00
Reason for hospital admission
Total pancreatectomy-19
0.005
*
HbA1c (%)
5.7 ± 1.6
a
6.0 ± 1.2
a
0.34
Hb (g/dL)
9.4 ± 2.3
a
8.9 ± 1.2
a
0.82
Creatinine at enrollment
0.8 ± 0.3
a
1.2 ± 1.3
a
0.5
Duration of CGM wear (mean ± SD)
4 ± 2.8
a
4.2 ± 4.6
a
0.6
Medications used during CGM wear (Yes/No)
Acetaminophen <4 g/day
17/2
5/3
0.17
Acetaminophen >4 g/day
2/17 0/19
0/8
Hydroxyurea
0/8
Dialysis (Yes/No)
1/18
0/8
0.3
J tube feeding (Yes/No)
14/5
5/3
0.17
Conclusion:
Hospitalized TP patients spend considerable time above 180 mg/dL demonstrating the unmet need of optimal glucose monitoring in this cohort.
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