Background: Pancreatic calculi, characterized by calcified deposits in the pancreatic duct, often coexist with diabetes mellitus, complicating clinical management. The Puestow procedure, a surgical intervention for pancreatic calculi, impacts diabetes outcomes, necessitating comprehensive exploration. Objective: Aimed to assess the postoperative effects of diabetes in pancreatic calculi patients undergoing the Puestow procedure. Methods: A cohort of 25 case was conducted at Central Hospital Ltd Dhanmondi Dhaka, Bangladesh, from 2022 to 2023, underwent meticulous analysis post-Puestow procedure. DM control, insulin requirements, postoperative complications, and surgical outcomes were systematically assessed. Percentage analysis was employed to quantify results. Results: Post-Puestow, 80% of patients exhibited improved DM control. Overall, 86.67% in the Puestow arm showed positive responses, with 26.67% achieving complete response and 60% partial response. Surgical outcomes indicated a shorter recovery time in the Puestow arm (49 days) compared to 142 days in the control arm, demonstrating better patient compliance. Statistical analysis revealed a significant correlation between diabetes status and postoperative outcomes (p < 0.05). Conclusions: The Puestow procedure demonstrated favorable postoperative effects on diabetes among pancreatic calculi patients. Improved DM control and reduced insulin requirements underscore its potential impact. Mild complications and a moderate recovery period emphasize the procedure's feasibility. Tailored postoperative care considering diabetes status enhances overall outcomes.