A simple five-factor risk model for predicting new-onset diabetes after distal pancreatectomy

Background: New-onset diabetes mellitus (NODM) following distal pancreatectomy (DP) significantly impacts long-term quality of life. This study developed a prediction model for post-DP NODM. Methods: Retrospective analysis of 159 patients undergoing DP for benign/low-grade malignant lesions (2014–2023). Cox regression identified risk factors incorporated into a scoring system. Results: Among 130 non-diabetic patients, 26.9 ​% developed NODM (median 10 months). Five independent predictors: prediabetes (HR 11.02), concomitant splenectomy (HR 2.45), age ≥65 (HR 2.03), BMI ≥25 (HR 1.96), neck/proximal tumor (HR 1.50). The risk scoring system (0–10 points) stratified patients into low-risk (0–2 points), intermediate-risk (3–5 points), and high-risk (6–10 points) categories with significantly different cumulative incidence of NODM at 5 years (4.4 ​%, 27.9 ​%, and 87.5 ​%, respectively). AUC exceeded 0.85 across timepoints. Conclusions: This simple model enables accurate risk stratification for post-DP NODM, facilitating personalized counseling and tailored surveillance.