Spontaneous hypoglycaemia after pancreas transplantation in Type 1 diabetes mellitus.
Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP-Tx, n = 55), and isolated kidney or liver transplanted non-diabetic subjects on the same immunosuppressive regimen (CON-Tx, n = 14), underwent 1-day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP-Tx had lower PG than CON-Tx in the night and in the morning and higher insulin concentrations throughout the day. KP-Tx had lower PG nadirs than CON-Tx (4.40+/-0.05 vs 4.96+/-0.16 mmol l(-1), ANOVA p = 0.001). Nine per cent of KP-Tx had hypoglycaemic values (PG < or = 3.0 mmol l(-1)) in the profiles, both postprandial and postabsorptive, whereas none of CON-Tx did (p < 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia.
Battezzati
A
A
Department of Medicine, Istituto Scientifico San Raffaele, University of Milan, Milano, Italy. battezzati.alberto@mail.hsr.it
Bonfatti
D
D
Benedini
S
S
Calori
G
G
Caldara
R
R
Mazzaferro
V
V
Elli
A
A
Secchi
A
A
Di Carlo
V
V
Pozza
G
G
Luzi
L
L
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007328:Insulin / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000502:physiology; D016031:Liver Transplantation / Q000502:physiology; D008297:Male; D016035:Pancreas Transplantation / Q000502:physiology*; D011183:Postoperative Complications; D013997:Time Factors
D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin