Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Background:

Pancreatectomy can lead to development of new-onset diabetes[1]. A previous audit showed little evidence of collaboration between Surgical and Medical teams in managing hyperglycaemia post-pancreatectomy[2].

Aim:

To evaluate the effect of a new pre-referral protocol introduced in August 2016 for patients undergoing pancreatectomy.

Methods:

We conducted a de-identified retrospective review of patients presenting to a South Western Sydney public hospital for pancreatic resection between January 2016 and April 2017. Data were collected from the Department of Surgery electronic database and medical record charts. Data collected included surgery type, diagnosis of diabetes prior to surgery and evidence of collaboration between the Surgical and Medical teams. Patients were divided into three groups: prior diagnosis of diabetes (group 1), new-onset diabetes (group 2) and nil diabetes post-operatively (group 3). Patient referral status and outcomes were compared between patients pre and post new referral protocol commencement. Outcomes included length of stay, complications (DKA, hyperglycaemia, diabetes) and post-surgery therapy.

Results:

A total of 41 patients underwent pancreatectomy, mean age 64.1, 64.3% males. Presentations were 29 pancreatic cancer, 7 neuroendocrine tumours, 2 benign pancreatic masses, 1 chronic pancreatitis and 2 other pathologies. There were 34 Whipple’s, 6 sub-total and 2 distal pancreatectomies. Fourteen patients had a prior diagnosis of type 2 diabetes. Thirty-seven patients (90%) developed hyperglycaemia post-operatively, 7 requiring insulin infusion. Twenty-seven patients (66%) were referred to the Diabetes Centre pre-operatively [95% post versus 38% before protocol introduction] and 23 (56%) were seen by the diabetes team as inpatients. In total, 26 (63%) patients were seen by the diabetes team either pre-operatively or during admission.

Conclusions:

There is evidence of increased collaboration between surgical and medical teams in the management of post-pancreatectomy hyperglycaemia, however more research is needed to identify how this impacts on outcomes such as post-surgical diabetes control and length of stay.