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PURPOSE: Impaired glycemic control is an important long-term consequence of distal pancreatectomy partially due to preferential β cell location in the body and tail, and nature of underlying pancreatic disease. Understanding the frequency of this outcome may alter the operative approach, including consideration of auto-islet transplantation.METHODS: A pathology database was interrogated to identify all patients who had undergone a distal pancreatectomy from 1990 through 2009. Demographic data, medication needed for glycemic control, histopathology, and volume resected were collected.RESULTS: 137 patients underwent distal pancreatectomy which included 26 (19%) that were diabetic preoperatively. New-onset diabetes was identified in 27 of remaining 111 patients (24.3%) with a mean time of onset of 6.4 months, and a median follow up of 25 months. Diabetes was seen more commonly in patients with chronic pancreatitis (5/13; 38.5%) and adenocarcinoma (7/22, 31.8%), but was not seen in patients undergoing resection for serous cystadenoma (0/8), or intraductal papillary mucinous neoplasm [IPMN] (0/9). Patients developing diabetes were older (63.4 vs. 55.1, p=0.01) but there was no difference in gender or ethnic distributions. The development of diabetes was not linked to the volume of parenchyma resected: lower volumes of tissue were resected in those with diabetes (119.2 cm3 vs 192.7 cm3; p=0.314); or related to patient body mass index [BMI] (29.3 KgM-2 vs 28.1 KgM-2; p=0.51). Of the 26 patients with pre-resection diabetes, 9 were taking insulin. In the remaining 17, 8 (47%) deteriorated and required insulin postoperatively. The development of postoperative impaired glycemic control was associated with prolonged hospital stay (12.6 days vs. 7.7 days; p=0.001).CONCLUSION: Impaired glycemic control is common following distal pancreatectomy, especially in those resected for chronic pancreatitis or cancer. In patients requiring distal pancreatectomy for chronic pancreatitis, improved outcome may include islet replacement.