Pancreatic necrosectomy is a standard treatment for patients with pancreatic necrosis, especially with evidence of infection and sepsis. Endocrine and exocrine insufficiency following pancreatic necrosectomy is described in several studies. We report the incidence and predictors of development of diabetes in long-term follow-up of 16 patients with pancreatic necrosectomy. Between January 2001 and December 2005, we retrospectively reviewed the records of all patients who had undergone open pancreatic necrosectomy at 2 university affiliated tertiary institutions. There were 16 patients in our study cohort. The mean age of the patients was 48.1 ± 15.7 years. Of the 16 patients, 6 were males and 10 were females. Of the 16 patients, 3 died of multisystem organ failure. Alcohol was the predominant cause of pancreatitis and pancreatic necrosis. Endocrine dysfunction was present in 5 of the 13 surviving patients. There was a strong positive correlation between the development of diabetes following pancreatic necrosectomy and number of surgical debridements for pancreatic necrosis during hospitalization (P = 0.04). Diabetes can develop in as many as 40% of patients following pancreatic necrosectomy. The number of surgical debridements for pancreatic necrosis is a major predictor for development of diabetes in these patients.