Incidence and risk factors for new-onset diabetes mellitus (NODM) in post-pancreatectomy patients diagnosed with pancreatic adenocarcinoma (PAC): A systematic review

ABSTRACT

Background: Pancreatic adenocarcinoma is a highly aggressive malignancy often requiring pancreatectomy as part of curative treatment. However, pancreatectomy frequently leads to endocrine dysfunction, such as new-onset diabetes mellitus (NODM). But the relationship between post pancreatectomy NODM and pancreatic carcinoma and the relevant risk factors remains underexplored.

Methods: In accordance with the PRISMA guidelines, a systematic search for pertinent studies was conducted across electronic databases including MEDLINE, Cochrane, EMBASE, and Scopus, covering the period from January 2000 to March 2025. The quality of these studies was evaluated using the Newcastle-Ottawa Scale, specifically designed for cohort studies. Subgroup analysis was done in terms of different pancreatectomy procedures.

Results: 45 quantitative studies were analysed, of which 16 (35.5%) were prospective studies and 29 (64.5%) were retrospective studies. Regarding the subgroup analysis, 11 studies analysed Pancreatico-Duodenectomy (PD) alone, another 12 studies analysed Distal Pancreatectomy (DP) alone, and the rest of the 22 studies compared PD with DP. The overall incidence of NODM was 24.5%, with the PD group incidence being 23.2%, and the DP group incidence was 26.3%. Older age, High BMI, preop hyperglycemia, pre-op high HbA1c, pre-existing chronic pancreatitis, low remnant pancreatic volume and post-operative complications were associated with a high incidence of NODM.

Conclusions: The development of NODM after partial pancreatic resections for pancreatic adenocarcinoma is a severe complication that requires prompt diagnosis, careful monitoring and systematic management. Hence, healthcare professionals should have detailed knowledge of the surgical procedure and its potential for diabetes complications postoperatively, using risk factor assessment.