FEBRUARY 25, 2013
Pancreatic weight: A game-changing screening test for diabetes

The weight of the pancreas may be useful in predicting who will eventually develop Type I diabetes mellitus says a study published in JAMA. Pancreatic atrophy has been reported to be associated with diabetes.

The authors weighed the pancreata (plural of pancreas) of 23 organ donors who did not have diabetes, 8 who had a positive screening test for test for diabetes-related autoantibodies and 20 who were known to have Type I diabetes.

The average weights of pancreata were as follows:

Those without diabetes (controls)--81.4 gm (95% CI, 73.0 gm-89.8 gm)
Those positive for a single autoantibody--61.3 gm (95% CI, 46.8 gm-75.8 gm; P = 0.02)
Those with Type I diabetes--44.9 gm (95% CI, 36.0 gm-53.9 gm; P = 0.001)

However, there was quite a bit of overlap of the values with the 95th and 5th percentiles being
108.5 gm & 55.6 gm, 79.8 gm & 33.2 gm, and 69.8 gm & 31.0 gm respectively.  

So the meaning of a pancreas that weighs, say 65 gm, which could be in any of the three categories, is not entirely clear.

The senior author was interviewed by MedPage Today and said that if the results can be validated, screening patients for early stages of pancreatic atrophy could be one implication of the work.

This seems like a great idea. Instead of have a painful blood test to screen for Type I diabetes antibodies, a patient could simply undergo a robotic total pancreatectomy. The pancreas could then be weighed in the OR and replaced at the time of the surgery.

This would not only be beneficial to the patient, it would help surgical residency training programs many of which see too few pancreatic cases to satisfy the requirements of the Residency Review Committee for Surgery and the American Board of Surgery.

Sure, some patients may suffer complications of the surgery. A recent study says that major complications occurred in 28% of those undergoing total pancreatectomy and the mortality rate was 8.5%. However, these patients were sick with 2/3 of them having cancer. 

It is likely that people who are not sick and undergo total pancreatectomy will fare much better. And don’t forget that robotic surgery is much safer than standard operations [unpublished data].

And the test would be worth it because patients who have skinny pancreata could be treated with a yet undiscovered drug that prevents pancreatic atrophy and Type I diabetes.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 4900 followers on Twitter.

More in Skeptical Scalpel
Infection and OR staff hair
Here's a question from a reader: We had an independent nurse ......
AUGUST 26, 2013
Wrong-site surgery and checklist (non)compliance
This week, we learned of two California hospitals which were ......
AUGUST 19, 2013
Follow up. How many authors does it takeā€¦
I recently blogged here on General Surgery News about the fact ......
AUGUST 12, 2013