Glycemic predictors of insulin independence after total pancreatectomy with islet autotransplantation

Michael Quartuccio, Erica Hall, Vikesh Singh, Martin A Makary, Kenzo Hirose, Niraj M Desai, Christi Walsh, Daniel Warren, Zhao Li Sun, Ellen Stein, Rita R. Kalyani

Research output: Contribution to journalArticle

Abstract

Context: Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in some patients. Predictors of insulin independence are needed for appropriate patient selection and counseling. Objective: To explore glycemic predictors of insulin independence after TPIAT. Design: A prospective cohort of patients. Methods: We investigated 34 patients undergoing TPIAT from 2011-2016 at Johns Hopkins Hospital, all had a 75-g oral glucose tolerance test (OGTT) administered prior to their TPIAT. The primary outcome was insulin independence 1 year after TPIAT. Results: Ten of 34 (29%) patients were insulin independent 1 year after TPIAT. All patients with impaired fasting glucose and/or impaired glucose tolerance preoperatively were insulin dependent at 1 year. In age-adjusted regression analyses, fasting glucose # 90 mg/dL [odds ratio (OR) = 6.56; 1.11 to 38.91; P = 0.04], 1-hour OGTT glucose # 143 mg/dL (OR = 6.65; 1.11 to 39.91; P = 0.04), and 2-hour OGTT glucose # 106 mg/dL (OR = 11.74; 1.46 to 94.14; P = 0.02) were significant predictors of insulin independence. In receiver operating characteristic analyses, homeostatic model assessment of b-cell function (HOMA-b) was the most robust predictor of insulin independence [area under the curve (AUC) = 0.88; 0.73 to 1.00]. Conclusions: Normal preoperative glucose status and lower fasting and postchallenge OGTT glucose values are significant predictors of insulin independence after TPIAT. Higher islet function (HOMA-b) was the strongest predictor. OGTT testing may be a useful tool to aid in patient counseling prior to TPIAT and should be further investigated.

Original languageEnglish (US)
Pages (from-to)801-809
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Islets of Langerhans Transplantation
Pancreatectomy
Autologous Transplantation
Insulin
Glucose Tolerance Test
Glucose
Fasting
Odds Ratio
Counseling
Glucose Intolerance
Chronic Pancreatitis
ROC Curve
Patient Selection
Area Under Curve
Regression Analysis
Medical problems
Refractory materials

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

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title = "Glycemic predictors of insulin independence after total pancreatectomy with islet autotransplantation",
abstract = "Context: Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in some patients. Predictors of insulin independence are needed for appropriate patient selection and counseling. Objective: To explore glycemic predictors of insulin independence after TPIAT. Design: A prospective cohort of patients. Methods: We investigated 34 patients undergoing TPIAT from 2011-2016 at Johns Hopkins Hospital, all had a 75-g oral glucose tolerance test (OGTT) administered prior to their TPIAT. The primary outcome was insulin independence 1 year after TPIAT. Results: Ten of 34 (29{\%}) patients were insulin independent 1 year after TPIAT. All patients with impaired fasting glucose and/or impaired glucose tolerance preoperatively were insulin dependent at 1 year. In age-adjusted regression analyses, fasting glucose # 90 mg/dL [odds ratio (OR) = 6.56; 1.11 to 38.91; P = 0.04], 1-hour OGTT glucose # 143 mg/dL (OR = 6.65; 1.11 to 39.91; P = 0.04), and 2-hour OGTT glucose # 106 mg/dL (OR = 11.74; 1.46 to 94.14; P = 0.02) were significant predictors of insulin independence. In receiver operating characteristic analyses, homeostatic model assessment of b-cell function (HOMA-b) was the most robust predictor of insulin independence [area under the curve (AUC) = 0.88; 0.73 to 1.00]. Conclusions: Normal preoperative glucose status and lower fasting and postchallenge OGTT glucose values are significant predictors of insulin independence after TPIAT. Higher islet function (HOMA-b) was the strongest predictor. OGTT testing may be a useful tool to aid in patient counseling prior to TPIAT and should be further investigated.",
author = "Michael Quartuccio and Erica Hall and Vikesh Singh and Makary, {Martin A} and Kenzo Hirose and Desai, {Niraj M} and Christi Walsh and Daniel Warren and Sun, {Zhao Li} and Ellen Stein and Kalyani, {Rita R.}",
year = "2017",
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day = "1",
doi = "10.1210/jc.2016-2952",
language = "English (US)",
volume = "102",
pages = "801--809",
journal = "Journal of Clinical Endocrinology and Metabolism",
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TY - JOUR

T1 - Glycemic predictors of insulin independence after total pancreatectomy with islet autotransplantation

AU - Quartuccio, Michael

AU - Hall, Erica

AU - Singh, Vikesh

AU - Makary, Martin A

AU - Hirose, Kenzo

AU - Desai, Niraj M

AU - Walsh, Christi

AU - Warren, Daniel

AU - Sun, Zhao Li

AU - Stein, Ellen

AU - Kalyani, Rita R.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Context: Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in some patients. Predictors of insulin independence are needed for appropriate patient selection and counseling. Objective: To explore glycemic predictors of insulin independence after TPIAT. Design: A prospective cohort of patients. Methods: We investigated 34 patients undergoing TPIAT from 2011-2016 at Johns Hopkins Hospital, all had a 75-g oral glucose tolerance test (OGTT) administered prior to their TPIAT. The primary outcome was insulin independence 1 year after TPIAT. Results: Ten of 34 (29%) patients were insulin independent 1 year after TPIAT. All patients with impaired fasting glucose and/or impaired glucose tolerance preoperatively were insulin dependent at 1 year. In age-adjusted regression analyses, fasting glucose # 90 mg/dL [odds ratio (OR) = 6.56; 1.11 to 38.91; P = 0.04], 1-hour OGTT glucose # 143 mg/dL (OR = 6.65; 1.11 to 39.91; P = 0.04), and 2-hour OGTT glucose # 106 mg/dL (OR = 11.74; 1.46 to 94.14; P = 0.02) were significant predictors of insulin independence. In receiver operating characteristic analyses, homeostatic model assessment of b-cell function (HOMA-b) was the most robust predictor of insulin independence [area under the curve (AUC) = 0.88; 0.73 to 1.00]. Conclusions: Normal preoperative glucose status and lower fasting and postchallenge OGTT glucose values are significant predictors of insulin independence after TPIAT. Higher islet function (HOMA-b) was the strongest predictor. OGTT testing may be a useful tool to aid in patient counseling prior to TPIAT and should be further investigated.

AB - Context: Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in some patients. Predictors of insulin independence are needed for appropriate patient selection and counseling. Objective: To explore glycemic predictors of insulin independence after TPIAT. Design: A prospective cohort of patients. Methods: We investigated 34 patients undergoing TPIAT from 2011-2016 at Johns Hopkins Hospital, all had a 75-g oral glucose tolerance test (OGTT) administered prior to their TPIAT. The primary outcome was insulin independence 1 year after TPIAT. Results: Ten of 34 (29%) patients were insulin independent 1 year after TPIAT. All patients with impaired fasting glucose and/or impaired glucose tolerance preoperatively were insulin dependent at 1 year. In age-adjusted regression analyses, fasting glucose # 90 mg/dL [odds ratio (OR) = 6.56; 1.11 to 38.91; P = 0.04], 1-hour OGTT glucose # 143 mg/dL (OR = 6.65; 1.11 to 39.91; P = 0.04), and 2-hour OGTT glucose # 106 mg/dL (OR = 11.74; 1.46 to 94.14; P = 0.02) were significant predictors of insulin independence. In receiver operating characteristic analyses, homeostatic model assessment of b-cell function (HOMA-b) was the most robust predictor of insulin independence [area under the curve (AUC) = 0.88; 0.73 to 1.00]. Conclusions: Normal preoperative glucose status and lower fasting and postchallenge OGTT glucose values are significant predictors of insulin independence after TPIAT. Higher islet function (HOMA-b) was the strongest predictor. OGTT testing may be a useful tool to aid in patient counseling prior to TPIAT and should be further investigated.

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U2 - 10.1210/jc.2016-2952

DO - 10.1210/jc.2016-2952

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VL - 102

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