Mapping global new-onset, worsening, and resolution of diabetes following partial pancreatectomy: A systematic review and meta-analysis

Abstract

Background & Aims: Partial pancreatectomy, commonly used for chronic pancreatitis, or pancreatic lesions, has diverse impacts on endocrine and metabolism system. The study aims to determine the global prevalence of new-onset, worsening, and resolution of diabetes following partial pancreatectomy. Methods: We searched PubMed, Embase, Web of Science and Cochrane Library from inception to October, 2023. DerSimonian-Laird random-effects model with Logit transformation was used. Sensitivity analysis, meta-regression and subgroup analysis were employed to investigate determinants of the prevalence of new-onset diabetes. Results: A total of 82 studies involving 13,257 patients were included. The overall prevalence of new-onset diabetes after partial pancreatectomy was 17.1%. Univariate meta-regression indicated that study size was the cause of heterogeneity. Multi-variable analysis suggested that income of country or area had the highest predictor importance (49.7%). For subgroup analysis, the prevalence of new-onset diabetes varied from 7.6% (France, 95% CI 4.3-13.0) to 38.0% (UK, 95% CI 28.2-48.8, P<.01) across different countries. Patients with surgical indications for chronic pancreatitis exhibited a higher prevalence (30.7%, 95% CI 21.8-41.3) than those with pancreatic lesions (16.4%, 95% CI 14.3-18.7, P<.01). The type of surgical procedure also influenced the prevalence, with distal pancreatectomy having the highest prevalence (23.7%, 95% CI 22.2-25.3, P<.01). Moreover, the prevalence of worsening and resolution of preoperative diabetes was 41.1% and 25.8%, respectively. Conclusions: Postoperative diabetes has a relatively high prevalence in patients undergoing partial pancreatectomy, which calls for attention and dedicated action from primary care physicians, specialists, and health policy makers alike.