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

Summary. Long-term normalization of glucose metabo-lism is necessary to prevent or ameliorate diabetic ompli-cations. Although pancreatic grafting is able to restore normal blood glucose and glycated haemoglobin, the de-gree of normalization ofthe deranged diabetic metabolism after pancreas transplantation is still questionable. Conse-quently glucose, insulin, C-peptide, glucagon, and pan-creatic polypeptide r sponses to oral glucose and i.v. argi-nine were measured in 36 Type 1 (insulin-dependen0 dia-betic recipients of pancreas and kidney aUografts and com-pared to ten healthy control subjects. Despite normal HbA1 (7.2_+0.2%; normal <8%) glucose disposal was nor-real only in 44 % and impaired in 56 % of the graft reci-pients, 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 re-cipients, Intravenous glucose tolerance (n=21) was normal in 67 % and borderline in 23%. Biphasic insulin release was seen in patients with normal glucose tolerance. Glu-cose tolerance did not deteriorate up to 7 years post-trans-plant. In addition, stress hormone release (cortisol, growth hormone, prolactin, glucagon, catecholamines) to insulin-induced hypoglycaemia was examined in 20 graft reci-pients and compared to eight healthy subjects. Reduced blood glucose decline indicates insulin resistance, but glu-cose recovery was normal, despite markedly reduced cate-cholamine and glucagon release. These data demonstrate the effectiveness of pancreatic grafting in normalizing glu-cose metabolism, although hyperinsulinaemia and de-ranged counterregulatory hormone response are observed frequently