DIABETES-MELLITUS IN PANCREATIC-CANCER FOLLOW-UP

The aim of this study was to assess the behavior of fasting serum gluc ose, C-peptide levels and OGTT in pancreatic cancer follow-up. We stud ied 49 patients with pancreatic cancer (stage I=8 pts; II=16 pts; III= 12 pts; IV=13 pts). At diagnosis 13/49 patients had fasting serum gluc ose levels of above 140 mg/dL. Of the remaining 36 pts, 22 underwent O GTT which indicated diabetes mellitus in 9/22 (41%) and impaired gluco se tolerance in 7/22 (32%) cases. C-peptide basal values were within t he normal range (0.8-2.0 mu g/L) in 14/49 (28%), above 2.0 mu g/L in 6 /49 (13%) and below 0.8 ug/L in 29/49 (59%) of the cases. No significa nt correlation was found between tumor stage or size and the presence of diabetes or of a reduced glucose tolerance. Twenty-four patients un derwent curative resection (group 1) and 16 palliative resection, whil e the remaining nine did not undergo surgery (group 2). Group 1 and 2 patients had a follow-up of 2 to 40 months (mean=14 months) and from 1 to 7.5 months (mean=3.5 months) respectively. In group 1 patients no significant difference was found between pre- and post-operative fasti ng serum glucose levels. However, in 11/15 (73%) patients who underwen t OGTT before and after surgery, an improvement in glucose tolerance w as observed after tumor resection. In group 2 patients, a significant increase in fasting serum glucose levels was found during follow-up. I n neither of the groups studied were significant variations found in C -peptide levels during the follow-up, although a slight increase was o bserved in patients who did not undergo surgery. In conclusion, the re duced glucose tolerance or frank diabetes mellitus, which frequently o ccurs during the onset of pancreatic cancer, does not seem to be relat ed to tumor stage or size. Curative resection ameliorates glucose into lerance, while tumor persistence can enhance serum glucose levels.