Spontaneous hypoglycaemia after pancreas transplantation in Type 1 diabetes mellitus

• Published in: Diabetic medicine Vol. 15; no. 12; pp. 991 - 996
• Main Authors: Battezzati, A., Bonfatti, D., Benedini, S., Calori, G., Caldara, R., Mazzaferro, V., Elli, A., Secchi, A., Carlo, V. Di, Pozza, G., Luzi, L.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.12.1998; Blackwell
• Subjects: Adult; Biological and medical sciences; blood glucose; Blood Glucose - metabolism; C-Peptide - blood; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - surgery; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - surgery; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; hypoglycaemia; Hypoglycemia - etiology; insulin; Insulin - blood; Kidney Failure, Chronic - surgery; Kidney Transplantation - physiology; Liver Transplantation - physiology; Male; Management. Various non-drug treatments. Langerhans islet grafts; Medical sciences; pancreas transplantation; Pancreas Transplantation - physiology; Postoperative Complications; Time Factors; Type 1 diabetes mellitus; Italy; Europe; Endocrinopathy; Human; Immunopathology; Prevalence; Liver; Autoimmune disease; Transplantation; Hypoglycemia; Kidney; Treatment; Surgery; Insulin dependent diabetes; Adult; Complication; Pancreas; Comparative study
• ISSN: 0742-3071; 1096-9136; 1464-5491
• DOI: 10.1002/(SICI)1096-9136(1998120)15:12<991::AID-DIA717>3.0.CO;2-Q

Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP‐Tx, n = 55), and isolated kidney or liver transplanted non‐diabetic subjects on the same immunosuppressive regimen (CON‐Tx, n = 14), underwent 1‐day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP‐Tx had lower PG than CON‐Tx in the night and in the morning and higher insulin concentrations throughout the day. KP‐Tx had lower PG nadirs than CON‐Tx (4.40 ± 0.05 vs 4.96 ± 0.16 mmol l−1, ANOVA p = 0.001). Nine per cent of KP‐Tx had hypoglycaemic values (PG ≤3.0 mmol l−1) in the profiles, both postprandial and postabsorptive, whereas none of CON‐Tx did (p < 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia. Copyright © 1998 John Wiley & Sons, Ltd.