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Endocrine Management and Clinical Outcomes in a Cohort of Pediatric Patients Undergoing Total Pancreatectomy with

Siobhan E Tellez1, Lindsey N Hornung2, David S Vitale3,4

  • 1Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Diabetes Technology & Therapeutics
|September 6, 2023
PubMed

Insights

Management strategies for pediatric total pancreatectomy with islet autotransplantation (TPIAT) lead to optimal endocrine outcomes. Pediatric TPIAT recipients achieved favorable glycemic control, with median HbA1C below 6.5% for the first three years post-surgery.

Area of Science:

  • Pediatric Endocrinology
  • Surgical Outcomes
  • Metabolic Disease Management

Background:

  • Total pancreatectomy with islet autotransplantation (TPIAT) is a complex procedure for pediatric patients with specific pancreatic conditions.
  • Effective endocrine management is crucial for long-term success and quality of life post-TPIAT.
  • Optimizing glycemic control in this population presents unique challenges.

Purpose of the Study:

  • To describe management strategies that contribute to optimal endocrine outcomes in pediatric TPIAT recipients.
  • To report on the endocrine management approach from initial evaluation through four years post-surgery.
  • To evaluate the impact of these strategies on post-TPIAT glycemic control.

Main Methods:

  • Retrospective review of endocrine outcome data from 86 pediatric TPIAT recipients.
  • Analysis of glycemic control, including HbA1C levels, at multiple time points up to 4 years post-transplantation.
  • Description of modified management protocols employed at the institution.

Main Results:

  • Median HbA1C remained below the 6.5% goal through the first three years post-TPIAT.
  • At 12 months, median HbA1C was 6.0%; at 2 years, it was 6.4%; and at 3 years, it was 6.5%.
  • By 4 years post-TPIAT, median HbA1C was 7.2%, indicating sustained but slightly increased glycemic levels.

Conclusions:

  • Pediatric TPIAT recipients at this institution demonstrate favorable endocrine outcomes with modified management protocols.
  • The described management strategies appear effective in achieving and maintaining glycemic control in the initial years following TPIAT.
  • Continued monitoring and protocol adherence are essential for long-term endocrine health in pediatric TPIAT survivors.

Keywords:
Continuous glucose monitoringInsulin pumpInsulin therapyPediatricsTPIAT

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