*Purpose: Total pancreatectomy with islet auto-transplantation (TPIAT) is becoming the standard of care for patients with severe chronic pancreatitis (CP). However, it is necessary to evaluate and select patients that can benefit from this lengthy procedure. Several patients with CP also have underlying diabetes, which may be due to insulin resistance (Type 2 Diabetes), loss of endocrine function (Type 3c Diabetes) or surgically induced due to resection of part of the pancreas. In this study, we performed a comparative analysis of the outcomes of TPIAT procedure in our diabetic and non-diabetic patient cohorts. The goal of this analysis is to understand the benefits of TPIAT procedure on patients who are diabetic.

*Methods: A total of 36 Patients who underwent TPIAT at Virginia Commonwealth University from June 2016 to October 2019 have been included in this study. 10 out of 36 patients were diabetic before undergoing TPIAT and were either insulin-dependent or under other diabetic medications and with an HbA1c of more than 6.0%. Islet isolation outcomes were compared along with metabolic outcomes and pain management data at 1-, 3-, 6-months, and 1-year post-transplantation. Maintenance of hypoglycemic awareness was also assessed in these patients.

*Results: Islet isolation yields in patients who were diabetic and non-diabetic at the time of transplantation were not significantly different (Diabetic vs. Non-Diabetic; 263578±213953 vs. 363051±239344; P=0.13). All Patients that were diabetic before TPIAT procedure continued to be insulin-dependent, whereas 40% of non-diabetic patients became insulin-independent at 1-year post-transplantation. Mean HbA1C percentage of diabetic patients at 1 year was greater than 7 and more than 80% of non-diabetic patients had an HbA1C less than 7%. Most interestingly, narcotic dependence was reduced in more than 50% at 1 year in patients with diabetes which was similar to patients who were non-diabetic. Similarly, pain scores were also reduced in patients equally regardless of their diabetic status prior to transplantation.

*Conclusions: Pre-transplant diabetes should not be considered as a contraindication for TPIAT, as these patients can maintain hypoglycemic awareness after transplantation of islets which is a major benefit. Moreover, narcotic-dependence can be reduced significantly in CP after TPIAT in both diabetic and non-diabetic patients.

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