PMID- 35007330
OWN - NLM
STAT- MEDLINE
DCOM- 20220309
LR  - 20230202
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 45
IP  - 2
DP  - 2022 Feb 1
TI  - Predictors of Glycemic Outcomes at 1 Year Following Pediatric Total 
      Pancreatectomy With Islet Autotransplantation.
PG  - 295-302
LID - 10.2337/dc21-1222 [doi]
AB  - OBJECTIVE: Total pancreatectomy with islet autotransplantation (TPIAT) is 
      indicated to alleviate debilitating pancreas-related pain and mitigate diabetes 
      in patients with acute recurrent and chronic pancreatitis when medical/endoscopic 
      therapies fail. Our aim was to evaluate predictors of insulin requirement at 1 
      year following TPIAT in a cohort of children. RESEARCH DESIGN AND METHODS: This 
      was a review of 43 pediatric patients followed after TPIAT for 1 year or longer. 
      Primary outcome was insulin use at 1 year, categorized as follows: insulin 
      independent, low insulin requirement (<0.5 units/kg/day), or high insulin 
      requirement (>/=0.5 units/kg/day). RESULTS: At 1 year after TPIAT, 12 of 41 (29%) 
      patients were insulin independent and 21 of 41 (51%) had low and 8 of 41 (20%) 
      had high insulin requirement. Insulin-independent patients were younger than 
      those with low and high insulin requirement (median age 8.2 vs. 14.6 vs. 13.1 
      years, respectively; P = 0.03). Patients with insulin independence had a higher 
      number of transplanted islet equivalents (IEQ) per kilogram body weight (P = 
      0.03) and smaller body surface area (P = 0.02), compared with those with insulin 
      dependence. Preoperative exocrine insufficiency was associated with high insulin 
      requirement (P = 0.03). Higher peak C-peptide measured by stimulated mixed-meal 
      tolerance testing (MMTT) at 3 and 6 months post-TPIAT was predictive of lower 
      insulin requirement at 1 year (P = 0.006 and 0.03, respectively). CONCLUSIONS: We 
      conclude that insulin independence following pediatric TPIAT is multifactorial 
      and associated with younger age, higher IEQ per kilogram body weight 
      transplanted, and smaller body surface area at time of operation. Higher peak 
      C-peptide measured by MMTT following TPIAT confers a higher likelihood of low 
      insulin requirement.
CI  - (c) 2022 by the American Diabetes Association.
FAU - Swauger, Sarah E
AU  - Swauger SE
AUID- ORCID: 0000-0001-7298-4959
AD  - Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 
      Cincinnati, OH.
FAU - Hornung, Lindsey N
AU  - Hornung LN
AD  - Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital 
      Medical Center, Cincinnati, OH.
FAU - Elder, Deborah A
AU  - Elder DA
AD  - Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 
      Cincinnati, OH.
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
FAU - Balamurugan, Appakalai N
AU  - Balamurugan AN
AD  - Division of Pediatric General and Thoracic Surgery, Cincinnati Children's 
      Hospital Medical Center, Cincinnati, OH.
AD  - Department of Surgery, University of Cincinnati College of Medicine Cincinnati, 
      OH.
FAU - Vitale, David S
AU  - Vitale DS
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
AD  - Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's 
      Hospital Medical Center, Cincinnati, OH.
FAU - Lin, Tom K
AU  - Lin TK
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
AD  - Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's 
      Hospital Medical Center, Cincinnati, OH.
FAU - Nathan, Jaimie D
AU  - Nathan JD
AD  - Division of Pediatric General and Thoracic Surgery, Cincinnati Children's 
      Hospital Medical Center, Cincinnati, OH.
AD  - Department of Surgery, University of Cincinnati College of Medicine Cincinnati, 
      OH.
FAU - Abu-El-Haija, Maisam
AU  - Abu-El-Haija M
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
AD  - Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's 
      Hospital Medical Center, Cincinnati, OH.
LA  - eng
SI  - figshare/10.2337/figshare.17072708
GR  - K23 DK118190/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Blood Glucose)
SB  - IM
MH  - Blood Glucose
MH  - Child
MH  - Humans
MH  - *Islets of Langerhans Transplantation
MH  - Pancreatectomy
MH  - *Pancreatitis, Chronic/surgery
MH  - Transplantation, Autologous
MH  - Treatment Outcome
PMC - PMC8914422
EDAT- 2022/01/11 06:00
MHDA- 2022/03/11 06:00
PMCR- 2023/02/01
CRDT- 2022/01/10 17:24
PHST- 2021/06/11 00:00 [received]
PHST- 2021/11/23 00:00 [accepted]
PHST- 2022/01/11 06:00 [pubmed]
PHST- 2022/03/11 06:00 [medline]
PHST- 2022/01/10 17:24 [entrez]
PHST- 2023/02/01 00:00 [pmc-release]
AID - 139196 [pii]
AID - 211222.45.2 [pii]
AID - 10.2337/dc21-1222 [doi]
PST - ppublish
SO  - Diabetes Care. 2022 Feb 1;45(2):295-302. doi: 10.2337/dc21-1222.