Utility of glucagon stimulation test in type 1 diabetes after pancreas transplantation.
BACKGROUND
Despite recent progress of immunosuppressive therapy with newly developed agents, long-term pancreatic graft survival after pancreas transplantation still remains low. Therefore, precise assessment of β-cell function after pancreas transplantation is necessary.


METHODS
Pancreatic β-cell secretory activity was measured by means of the peripheral plasma fasting serum C-peptide (CPR) response to 1 mg of glucagon intravenously in 23 patients after pancreas transplantation. The utility of ΔCPR after injection was compared with other indices that reflect insulin secretion.


RESULTS
When we performed the test, 6 patients still needed insulin injection after the transplantation. Mean CPR before and after glucagon intravenously were 1.9 ± 0.98 ng/mL and 4.6 ± 2.29 ng/mL, respectively. Fasting serum CPR, secretory unit of islet in transplantation (SUIT) index, and ΔCPR after glucagon injection were significantly different between insulin users and nonusers. During follow-up (501 ± 228 days), 3 patients could stop using insulin, and their increase of CPR (1.8 ± 0.5 ng/mL) was significantly higher than that in continuous insulin users (0.3 ± 0.3 ng/mL).


CONCLUSIONS
Fasting CPR, SUIT index, and ΔCPR after glucagon injection could reflect β-cell function for post-pancreas transplant patients, and glucagon stimulation test could give us additional information to predict insulin-free treatment.
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
I
I
Hiratsuka
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan. Electronic address: aslapin@fujita-hu.ac.jp.
A
A
Suzuki
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
M
M
Kondo-Ando
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
H
H
Hirai
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
Y
Y
Maeda
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
S
S
Sekiguchi-Ueda
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
M
M
Shibata
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
T
T
Takayanagi
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
M
M
Makino
Department of Urology, Fujita Health University, Toyoake, Aichi, Japan.
N
N
Fukami
Department of Organ Transplant Surgery, Fujita Health University, Toyoake, Aichi, Japan.
T
T
Itoh
Department of Urology, Fujita Health University, Toyoake, Aichi, Japan.
H
H
Sasaki
Department of Urology, Fujita Health University, Toyoake, Aichi, Japan.
M
M
Kusaka
Department of Organ Transplant Surgery, Fujita Health University, Toyoake, Aichi, Japan.
T
T
Kenmochi
Department of Urology, Fujita Health University, Toyoake, Aichi, Japan.
K
K
Hoshinaga
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
M
M
Itoh
D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism* / Q000601:surgery; D005934:Glucagon / Q000008:administration & dosage*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D016035:Pancreas Transplantation
D002096:C-Peptide; D007328:Insulin; D005934:Glucagon