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Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team
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作者 Vasileios K Mavroeidis Jennifer Knapton +1 位作者 Francesca Saffioti Daniel L Morganstein 《World Journal of Diabetes》 SCIE 2024年第4期598-605,共8页
Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralis... Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined,a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis.Therefore,pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams.With the ongoing accumulation of evidence,it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients. 展开更多
关键词 PANCREATECTOMY PANCREATODUODENECTOMY Whipple’s PANCREATITIS Diabetes specialist Type 3c pancreatogenic diabetes mellitus
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Post-acute pancreatitis diabetes:A complication waiting for more recognition and understanding 被引量:1
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作者 Diego García-Compeán Alan R Jiménez-Rodríguez +3 位作者 Juan M Muñoz-Ayala José A González-González Héctor J Maldonado-Garza Jesús Z Villarreal-Pérez 《World Journal of Gastroenterology》 SCIE CAS 2023年第28期4405-4415,共11页
Post-acute pancreatitis diabetes(PAPD)is the second most common type of diabetes below type 2 diabetes mellitus.Due to the boom in research on this entity carried out during the last decade,its recognition has increas... Post-acute pancreatitis diabetes(PAPD)is the second most common type of diabetes below type 2 diabetes mellitus.Due to the boom in research on this entity carried out during the last decade,its recognition has increased.However,much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis(AP).Recent prospective cohort studies show that its incidence is about 23%globally and 34.5%in patients with severe AP.With the overall increase in the incidence of AP this complication will be certainly seen more frequently.Due to its high morbidity,mortality and difficult control,early detection and treatment are essential.However,its risk factors and pathophysiological mechanisms are not clearly defined.Its diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP episodes.This review will show the evidence published so far on the incidence and prevalence,risk factors,possible pathophysiological mechanisms,clinical outcomes,clinical characteristics and preventive and corrective management of PAPD.Some important gaps needing to be clarified in forthcoming studies will also be discussed. 展开更多
关键词 Acute pancreatitis Diabetes mellitus Chronic pancreatitis Post-pancreatitis diabetes pancreatogenic diabetes
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Diagnosis and treatment of diabetes mellitus in chronic pancreatitis 被引量:25
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作者 Nils Ewald Philip D Hardt 《World Journal of Gastroenterology》 SCIE CAS 2013年第42期7276-7281,共6页
Diabetes secondary to pancreatic diseases is commonly referred to as pancreatogenic diabetes or type 3c diabetes mellitus.It is a clinically relevant condition with a prevalence of 5%-10%among all diabetic subjects in... Diabetes secondary to pancreatic diseases is commonly referred to as pancreatogenic diabetes or type 3c diabetes mellitus.It is a clinically relevant condition with a prevalence of 5%-10%among all diabetic subjects in Western populations.In nearly 80%of all type 3c diabetes mellitus cases,chronic pancreatitis seems to be the underlying disease.The prevalence and clinical importance of diabetes secondary to chronic pancreatitis has certainly been underestimated and underappreciated so far.In contrast to the management of type 1 or type2 diabetes mellitus,the endocrinopathy in type 3c is very complex.The course of the disease is complicated by additional present comorbidities such as maldigestion and concomitant qualitative malnutrition.General awareness that patients with known and/or clinically overt chronic pancreatitis will develop type 3c diabetes mellitus(up to 90%of all cases)is rather good.However,in a patient first presenting with diabetes mellitus,chronic pancreatitis as a potential causative condition is seldom considered.Thus many patients are misdiagnosed.The failure to correctly diagnose type 3 diabetes mellitus leads to a failure to implement an appropriate medical therapy.In patients with type 3c diabetes mellitus treating exocrine pancreatic insufficiency,preventing or treating a lack of fat-soluble vitamins(especially vitamin D)and restoring impaired fat hydrolysis and incretin secretion are key-features of medical therapy. 展开更多
关键词 DIABETES MELLITUS CHRONIC PANCREATITIS TYPE 3c DIABETES pancreatogenic DIABETES PANCREATITIS
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Relationship between the exocrine and endocrine pancreas after acute pancreatitis 被引量:9
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作者 Stephanie L M Das James I C Kennedy +3 位作者 Rinki Murphy Anthony R J Phillips John A Windsor Maxim S Petrov 《World Journal of Gastroenterology》 SCIE CAS 2014年第45期17196-17205,共10页
AIM: To determine the prevalence and time course of pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis.
关键词 pancreatogenic diabetes Pancreatic exocrine insufficiency Acute pancreatitis Endocrine insufficiency
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Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm 被引量:4
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作者 Gianpaolo Balzano Michele Carvello +7 位作者 Lorenzo Piemonti Rita Nano Riccardo Ariotti Alessia Mercalli Raffaella Melzi Paola Maffi Marco Braga Carlo Staudacher 《World Journal of Gastroenterology》 SCIE CAS 2014年第14期4030-4036,共7页
AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck.
关键词 Pancreas Benign neoplasm Laparoscopy Minimally invasive treatment Spleen preservation pancreatogenic diabetes Autologous islet transplantation
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