title: Deterioration of glycemic control after corticosteroid administration in islet autotransplant recipients: a cautionary tale.
abstract: Islet autotransplantation (IAT) is performed at the time of total pancreatectomy (TP) to prevent or minimize post-surgical diabetes. Corticosteroids induce insulin resistance and present a risk to islet autografts, through glucotoxicity and increased metabolic demand on a marginal islet mass. We present four IAT recipients treated with oral or injected corticosteroids after transplant for medical conditions unrelated to chronic pancreatitis or TPIAT. Hyperglycemia or insulin resistance was evident in all four patients, including reversion to long-term insulin therapy in two patients. One patient receiving corticosteroid injections had a transient increase in hemoglobin A1c (+0.6% above baseline), and one patient given a one time dose of oral dexamethasone exhibited hyperglycemia despite high insulin (>200 mU/L) and C-peptide (15.3 ng/mL) production on an oral glucose tolerance test. IAT recipients have insufficient islet mass to compensate for the insulin resistance induced by corticosteroids. Caution should be given to using these agents in IAT recipients. When corticosteroids are medically necessary, insulin therapy should be administered temporarily to compensate for the increased metabolic demand and minimize long-term risks on the islet graft.
authors.affiliation: Des Moines University, College of Osteopathic Medicine, Des Moines, IA, USA.
authors.forename: Anh
authors.initials: A
authors.lastname: Ngo
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000534:rehabilitation; D008875:Middle Aged; D059408:Pain Management / Q000009:adverse effects; D010180:Pancreatectomy; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014581:Urticaria / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human