Metabolic and hormonal studies of Type 1 (insulin-dependent) diabetic patients after successful pancreas and kidney transplantation

Landgraf, R.; Nusser, J.; Riepl, Rudolf L.; Fiedler, F.; Illner, Wolf-Dieter; Abendroth, D. und Land, Walter (August 1991): Metabolic and hormonal studies of Type 1 (insulin-dependent) diabetic patients after successful pancreas and kidney transplantation. In: Diabetologia, Bd. 34, Nr. Supple: S. 61-67

Abstract

Long-term normalization of glucose metabolism is necessary to prevent or ameliorate diabetic complications. Although pancreatic grafting is able to restore normal blood glucose and glycated haemoglobin, the degree of normalization of the deranged diabetic metabolism after pancreas transplantation is still questionable. Consequently glucose, insulin, C-peptide, glucagon, and pancreatic polypeptide responses to oral glucose and i.v. arginine were measured in 36 Type 1 (insulin-dependent) diabetic recipients of pancreas and kidney allografts and compared to ten healthy control subjects. Despite normal HbA1 (7.2±0.2%; normal <8%) glucose disposal was normal only in 44% and impaired in 56% of the graft recipients. Normalization of glucose tolerance was achieved at the expense of hyperinsulinaemia in 52% of the subjects. C-peptide and glucagon were normal, while pancreatic polypeptide was significantly higher in the graft recipients. Intravenous glucose tolerance (n=21) was normal in 67% and borderline in 23%. Biphasic insulin release was seen in patients with normal glucose tolerance. Glucose tolerance did not deteriorate up to 7 years post-transplant. In addition, stress hormone release (cortisol, growth hormone, prolactin, glucagon, catecholamines) to insulin-induced hypoglycaemia was examined in 20 graft recipients and compared to eight healthy subjects. Reduced blood glucose decline indicates insulin resistance, but glucose recovery was normal, despite markedly reduced catecholamine and glucagon release. These data demonstrate the effectiveness of pancreatic grafting in normalizing glucose metabolism, although hyperinsulinaemia and deranged counterregulatory hormone response are observed frequently.

• Dokumententyp: Zeitschriftenartikel
• Keywords: Pancreas transplantation, Glucose tolerance, Islet hormone release, Counterregulatory hormones
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit

Literaturliste

Amiel SA, Tamborlane WV, Simonson DC, Sherwin RS (1987) Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. N Engl J Med 316:1376–1383

Baron AD, Wallace P, Brechtel G (1987) In vivo regulation of non insulin-mediated and insulin-mediated glucose uptake by cortisol. Diabetes 36:1230–1237

Bolli GB, De Feo P, Compagnucci P, Cartechini MG, Angeletti G, Santeusanio F, Brunetti P, Gerich JE (1983) Abnormal glucose counterregulation in insulin-dependent diabetes mellitus. Interaction of anti-insulin antibodies and impaired glucagon and epinephrine secretion. Diabetes 32:134–141

Bosi E, Piatti PM, Secchi A, Monti LD, Traeger J, Dubernard JM, Pozza G (1988) Response of glucagon and insulin secretion to insulin-induced hypogycemia in type I diabetic recipients after pancreatic transplantation. Diab Nutr Metab 1:21–27

Diem P, Abid M, Redmon JB, Sutherland DER, Robertson RP (1990a) Systemic venous drainage of pancreas allografts as independent cause of hyperinsulinemia in type I diabetic recipients. Diabetes 39:534–540

Diem P, Redmon JB, Abid M, Moran A, Sutherland DER, Halter JB, Robertson RP (1990b) Glucagon, catecholamine, and pancreatic polypeptide secretion in type I diabetic recipients of pancreas allografts. J Clin Invest 86:2008–2013

Dubernard JM, Sutherland DER (eds) (1989) International Handbook of Pancreas Transplantation. Kluwer Academic Publishers, Dordrecht Boston London

Eaton RP, Allen RC, Schade DS (1983) Hepatic removal of insulin in normal man: dose response to endogenous insulin secretion. J Clin Endocrinol Metab 56:1294–1300

Glaser B, Vinik AI, Sive AA, Floyd JC (1980) Plasma human pancreatic polypeptide responses to administered secretion: effects of surgical vagotomy, cholinergic blockade and chronic pancreatitis. J Clin Endocrinol Metab 50:1094–1099

Groth CG (ed) (1989) Proceedings First International Congress on Pancreatic and Islet Transplantation. Diabetes 38 (Suppl 1) 1–335

Hanssen KF, Dahl-Jørgensen K, Lauritzen T, Feldt-Rasmussen B, Brinchmann-Hansen O, Deckert T (1986) Diabetic control and microvascular complications: the near-normoglycaemic experience. Diabetologia 29:677–684

Heding LG (1979) Radioimmunological determination of pancreatic and gut glucagon in plasma. Diabetologia 7:10–19

Jarrett RJ (1988) Is insulin atherogenic? Diabetologia 31:71–75

Land W, Landgraf R (1987) Clinical pancreas transplantation. — The world experience. Transplant Proc 19 (Suppl 4) 1–102

Land W, Landgraf R, Illner WD, Abendroth D, Kampik A, Jensen U, Lenhart FP, Burg D, Hillebrand G, Castro LA, Landgraf-Leurs MMC, Frey L, Gokel M, Schleibner H, Nusser J, Ulbig M (1987) Clinical pancreatic transplantation using the prolamine duct occlusion technique. — The Munich experience. Transplant Proc 19 (Suppl 4) 75–83

Landgraf R, Nusser J, Scheuer R, Fiedler F, Scheider A, Meyer-Schwickerath E, Müller-Felber W, Illner WD, Abendroth D, Land W (1989) Metabolic control and effect on secondary complications of diabetes mellitus by pancreatic transplantation. Bailliere's Clinical Gastroenterology 3:865–876

Luzi L, Secchi A, Facchini F, Battezzati A, Staudacher C, Spotti D, Castoldi R, Ferrari G, Di Carlo V, Pozza G (1990) Reduction of insulin resistance by combined kidney-pancreas transplantation in Type 1 (insulin-dependent) diabetic patients. Diabetologia 33:549–556

Najarian JS, Sutherland DER, Groth CG (Guest Eds) (1990) Second International Congress on Pancreatic and Islet Cell Transplantation. Transplant Proc 22:569–883

Nusser J, Huber RM, Scheuer R, Tatsch K, Kirsch CM, Landgraf R (1988) Pulmonary and esophageal dysfunction as a part of autonomic dysfunction. Diabetologia 31:527A

Östman J, Gunnarsson R, Groth CG (1988) Metabolic control after pancreas transplantation. In: Groth CG (ed) Pancreatic Transplantation. WB Saunders & Co, Philadelphia London, pp 291–314

Osei K, Henry ML, O'Dorisio TM, Tesi RJ, Sommer BG, Ferguson RM (1990) Physiological and pharmacological stimulation of pancreatic islet hormone secretion in type I diabetic pancreatic allograft recipients. Diabetes 39:1235–1242

Passon PG, Peuler JD (1973) Original-Einzelisotopen-Radioenzymatischer Assay für Catecholamine. Analyt Biochem 51:618–631

Peuler JD, Johnson GA (1977) Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine, and dopamine. Life Sciences 21:625–636

Riepl RL, Lehnert P, Scharl A, Hempen I, Fiedler F, Teufel J, Burhol PG (1990) Effect of intraduodenal bile and Na-taurodioxycholate on exocrine pancreatic secretion and on plasma levels of secretin, pancreatic polypeptide, and gastrin in man. Scand J Gastroenterl 25:45–53

Schwartz TW (1983) Pancreatic polypeptide: a hormone under vagal control. Gastroenterology 85:1411–1425

Stalla GK, Giessmann G, Müller OA, Wood WG, Scriba PC (1981) The development of a direct homologous radioimmunoassay for serum cortisol. J Clin Chem Clin Biochem 19:427–434

Sutherland DER, Sibley R, Chinn P, Michael A, Srikanta S, Taub F, Najarian J, Goetz FC (1984) Twin to twin pancreas transplantations: reversal and reenactment of the pathogenesis of type I diabetes. Clin Res 32:56

Tydén G, Brattström C, Bolinder J, Bohman SO, Groth CG, Brekke IB, Holdaas H, Flatmark A (1989) Long-term metabolic control in recipients of segmental pancreas grafts with pancreaticoenterostomy or duct obstruction. Diabetes 38 (Suppl 1) 94–96

Weir GC, Bonner-Weir S, Leaky JL (1990) Islet mass and function in diabetes and transplantation. Diabetes 39:401–405

Werder K v (1975) Wachstumshormone und PRL-Sekretion des Menschen. Urban und Schwarzenberg, Berlin Heidelberg