The Effect of Corticosteroid Withdrawal on Glucose Metabolism and Anti-GAD Antibodies in Simultaneous Pancreas-Kidney Transplant Patients.
BACKGROUND
Corticosteroid withdrawal may reduce insulin resistance; however, it could also influence pancreatic autoantibody profile in simultaneous pancreas-kidney (SPK) transplant patients.


OBJECTIVE
To evaluate the effect of corticosteroid withdrawal on glucose metabolism and anti-glutamic acid decarboxylase (GAD) antibody titers in SPK patients with type 1 diabetes after 12 months of follow-up.


METHODS
In this retrospective study, fasting glucose and glycated hemoglobin (A1c) were compared before and after 3, 6, and 12 months of corticosteroid withdrawal in 80 SPK patients. In addition, weight, anti-GAD, and C-peptide levels were compared before and after withdrawal. Finally, fasting and postglucose, insulin, and C-peptide levels were compared before and after withdrawal in 25 patients undergoing oral glucose tolerance test (OGTT).


RESULTS
Fasting glucose levels did not change during corticosteroid discontinuation. After 12 months, A1c slightly increased from 4.6% (0.4%) to 4.8% (0.6%) (P < .01) and C-peptide decreased from 2.8 (1.1) ng/mL to 2.4 (1.3) ng/mL (P <. 01). In patients submitted to OGTT, glucose, insulin, and C-peptide levels did not change. There was no alteration in the proportion of anti-GAD positive tests (41% vs 45%). Anti-GAD titers remained stable or decreased in 70% of positive patients.


CONCLUSIONS
Corticosteroid withdrawal has no significant effect on glucose metabolism and on anti-GAD profile among SPK patients.
Diabetes Unit, Hospital Clínic de Barcelona, Barcelona, Spain Diabetes Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Rogério Silicani
RS
Ribeiro
Renal Transplant Unit, Hospital Clínic de Barcelona, Barcelona, Spain Hospital do Rim, Universidade Federal de São Paulo, Sao Paulo, Brazil.
Marina
M
Cristelli
Diabetes Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
Antonio J
AJ
Amor
Renal Transplant Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
Vanessa
V
Guerrero
Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Joana
J
Ferrer
Renal Transplant Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
María José
MJ
Ricart
Diabetes Unit, Hospital Clínic de Barcelona, Barcelona, Spain esmatjes@clinic.ub.es.
Enric
E
Esmatjes
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001323:Autoantibodies; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1; D005500:Follow-Up Studies; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007328:Insulin; D016030:Kidney Transplantation; D016035:Pancreas Transplantation; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D001323:Autoantibodies; D001786:Blood Glucose; D007328:Insulin; D005947:Glucose
anti-GAD antibodies; corticosteroids; glucose metabolism.; simultaneous pancreas–kidney transplantation; type 1 diabetes