Work

SUN-176 Endocrinology-Surgical Oncology Interdisciplinary Transitions of Care Improves Outcomes in Patients Undergoing Total Pancreatectomy

Year: 2024

Type: article

Abstract: C. Lewis: None. E. Rafi: None. J. Fetzner: None. L. Tranchito: None. J.E. Blanchette: None. N. Bellini: None. L. McCaulley: None. J. Winter: None. B. Hatipoglu: None. Introduction: Total pancreatectomy is a complex surgical procedure that involves removal of the entire pancreas, often in the setting of pancreatic malignancy or chronic pancreatitis. If islet cell transplantation does not occur, the patient is completely insulin dependent for life once the pancreas is removed. We aimed to evaluate the implementation of an interdisciplinary program between the endocrinology and surgical oncology departments to optimize the transition of care for patients undergoing total pancreatectomy with subsequent type 3c diabetes. Clinical Case: We present a case series of two patients: a female, age 71 (patient A) and a male, age 73 (patient B) who underwent total pancreatectomy for intraductal papillary mucinous neoplasms. Prior to surgery, patient A had a hemoglobin A1c of 5.8%. She had no history of diabetes and was not on any diabetes medications. Patient B did have type 2 diabetes but was historically able to maintain a hemoglobin A1c of less than 7% without any diabetes medications. He had a pre-surgery hemoglobin A1c of 7.2%. Before total pancreatectomy, patients A and B met with the endocrinology team, including PharmD, NP or MD, and CDCES. During hospitalization, they were seen by endocrinology again (PA, MD, nurse educator) and started on multiple daily injections (MDI) of insulin. Both patients were discharged from the hospital on MDI. They received follow-up at the diabetes center within one month of discharge. Four months after surgery, patient A was transitioned from MDI to continuous subcutaneous insulin infusion, utilizing automated insulin delivery technology. Patient A’s time in range (TIR) improved from 60% to 70%, and minimal hypoglycemia with AID implementation. Patient B was continued on MDI with continuous glucose monitoring (CGM). Five months after surgery, TIR was 72%, with a hemoglobin A1c of 5.4% and minimal hypoglycemia. Neither patient experienced hypoglycemia requiring external support or the use of glucagon. Conclusion: A new diagnosis of type 3c diabetes is often overwhelming for patients. In collaboration with the surgical team, we identified and provided anticipatory diabetes education to patients who were expected to have insulin dependence postoperatively. Both patients have been able to maintain TIR within goal. Key aspects of this program include in-depth patient education prior to surgery, understanding of treatment goals, and rapid follow-up post-procedure. Our cases highlight the benefit of receiving interdisciplinary services in order to improve clinical outcomes after total pancreatectomy. Sunday, June 2, 2024

Source: Journal of the Endocrine Society

DOI: 10.1210/jendso/bvae163.2370