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[2021/03/05]
Role of Intestinal Environment and Cellular Plasticity of Islets in Postpancreatectomy Diabetes
There are two types of partial pancreatectomy; pancreatoduodenectomy (PD) and distal pancreatectomy(DP). PD involves bypass of the proximal intestine and resection of the pancreatic head, whereas DP involves resection of the pancreatic body and tail without gastric bypass. With the resection of approximately half of the pancreas, both PD and DP can exacerbate glucose tolerance by reducing insulin secretion. However, it is uncertain whether the degree of deterioration in postoperative glucose tolerance by PD and DP is different. We have hypothesized that the altered intestinal environment after gut bypass affects glucose metabolism after PD. Because DP involves is a simple reduction of approximately half of the pancreas, it is also interesting to determine the association of histological features of the resected pancreas with the development of postpancreatectomy diabetes mellitus (PPDM).

Here, we conducted a prospective observational study of patients without diabetes (including those with impaired glucose tolerance) undergoing partial pancreatectomy. In this study, we demonstrated that PPDM incidence is much lower after PD than after DP; it may be partly because changes in the intestinal environment involving increased fecal short-chain fatty acids and altered gut microbiota composition prevent the deterioration of glucose metabolism via increased glucagon-like peptide 1 secretion after PD. We also found that islet expansion is associated with increased cellular plasticity in islets, which may serve as a valuable predictor of PPDM after DP. The data of this study highlight the importance of intestinal environment and cellular plasticity of islets in the development of PPDM, thereby providing new insight into the pathogenesis of type 2 diabetes.
Importance of Intestinal Environment and Cellular Plasticity of Islets in the Development of Postpancreatectomy Diabetes
Tatsuya Fukuda, Ryotaro Bouchi, Takato Takeuchi, Kikuko Amo-Shiinoki,Atsushi Kudo, Shinji Tanaka, Minoru Tanabe, Takumi Akashi, Kazuhiro Hirayama, Toshitaka Odamaki, Miki Igarashi, Ikuo Kimura, Katsuya Tanabe, Yukio Tanizawa, Tetsuya Yamada, and Yoshihiro Ogawa

Diabetes Care 
DOI:https://doi.org/10.2337/dc20-0864

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