Poor Glycemic Status Is Associated With Diabetes Distress After Total Pancreatectomy With Islet Autotransplantation

Diabetes distress (DD), the emotional burden of managing diabetes, affects glycemic outcomes and quality of life. While extensively studied in patients with type 1 and 2 diabetes, there is limited data in patients following total pancreatectomy with islet autotransplantation (TPIAT). This study evaluates predictors of DD, including insulin use, graft function, CGM metrics and acute diabetes complications.

We analyzed 124 patients from the long-term islet function and impact after TPIAT (LIFT) study, 5-20 years post-TPIAT. Mean scores were compared using t-tests and linear regression adjusted for demographic and clinical covariates.

The cohort was 73% female, median age 47 years, median A1C 6.6% with 81% achieving CGM time in range (TIR)>50%. Ninety-two percent had graft function (c-peptide≥0.6 ng/mL) and 31% were insulin independent. Insulin dependence was associated with higher DD (mean[SD]:1.78[0.70] vs. 1.52[0.64], p = 0.043).). TIR < 50% was linked to higher DD (2.10[0.76] vs. 1.57[0.70] for TIR>70%, p = 0.021) with the effect persisting after adjusting for confounders. A history of DKA and/or severe hypoglycemia was significantly associated with higher DD (2.15[0.98] vs 1.59[0.56], p = 0.012).

Insulin dependence and poor glycemic control are major contributors to DD. Addressing these factors is essential for improving both glycemic and psychosocial outcomes in this unique population.