Glucose homeostasis after simultaneous pancreas and kidney transplantation: a comparison of subjects with C-peptide-positive non-type 1 diabetes mellitus and type 1 diabetes mellitus.
BACKGROUND
While simultaneous pancreas kidney transplant (SPKTx) is a therapeutic option for patients with type 1 diabetes (T1DM) and renal failure, few centers offer SPKTx to "select" non-T1DM patients. To address concerns that existing insulin resistance may limit the benefits of the pancreas allograft among non-T1DM, we compared several indices of glucose homeostasis, in "select" non-T1DM and T1DM patients who received SPKTx.


METHODS
Criteria for "select" non-T1DM included the following: positive C-peptide, BMI <30 kg/m(2) , treatment with oral agents before insulin initiation, and insulin at <1 unit/kg/d. We compared several indices of glucose homeostasis within 1 yr post-SPKTx among seven "select" patients with non-T1DM and nine patients with T1DM with similar age, BMI, and immunosuppression. Measurements of insulin resistance included the following: homeostatic model, insulin sensitivity index, and insulin-glucose ratio; insulin secretion measures included the following: corrected insulin response.


RESULTS
Non-T1DM had similar pre-transplant metabolic (fasting glucose, HbA1c, blood pressure, and lipid) parameters to the T1DM cohort. There were no significant differences in the various measures of insulin resistance and secretion between T1DM and "select" non-T1DM patients.


CONCLUSIONS
Our results suggest SPKTx should be considered in the therapeutic armamentarium among carefully select non-T1DM with features of minimal insulin resistance; however, a larger cohort with longer follow-up is needed to confirm our results.
Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Harini A
HA
Chakkera
Division of Endocrinology and Metabolic Diseases, Mayo Clinic, Rochester, MN, USA.
Yogish C
YC
Kudva
Department of Research Biostatistics, Mayo Clinic, Phoenix, AZ, USA.
Yu-Hui H
YH
Chang
Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Raymond L
RL
Heilman
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Andrew L
AL
Singer
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Amit K
AK
Mathur
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Winston R
WR
Hewitt
Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Hasan A
HA
Khamash
Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Janna L
JL
Huskey
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Nitin N
NN
Katariya
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Adyr A
AA
Moss
Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Senaida
S
Behmen
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Kunam S
KS
Reddy
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007333:Insulin Resistance; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
D001786:Blood Glucose; D002096:C-Peptide
diabetes; insulin resistance; insulin secretion; pancreas transplant