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Exp Clin Endocrinol Diabetes 2002; 110(8): 420-424
DOI: 10.1055/s-2002-36429
Case Report

© Johann Ambrosius Barth

Combined Pancreas and Kidney Transplantation in a Lean Type 2 Diabetic Patient. Effects on Insulin Secretion and Sensitivity

C. Pox 1 , R. Ritzel 1 , M. Büsing 2 , J. J. Meier 1 , J. Klempnauer 2 , W. Schmiegel 1 , M. A. Nauck 1
  • 1 Department of Medicine, Ruhr-University Bochum, Knappschafts-Krankenhaus Bochum (Langendreer), Germany
  • 2 Department of Surgery, Ruhr-University Bochum, Knappschafts-Krankenhaus Bochum (Langendreer), Germany
Further Information

Publication History

received 30 December 2001 first decision 16 May 2002

accepted 16 May 2002

Publication Date:
08 January 2003 (online)

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Summary

Background/aims: Pancreas transplantation is an established method of treating Type 1 diabetes. It was our aim to test the consequences of pancreas transplantation in a Type 2 diabetic patient by determining insulin secretion and sensitivity before and after surgery.

Patients and methods: A female patient with Type 2 diabetes and end-stage nephropathy was treated with combined pancreas and kidney transplantation. Before surgery and at 4 weeks, 6 months and 2 years afterwards, insulin sensitivity was measured using hyperinsulinemic euglycemic clamps and insulin secretion was quantified after oral glucose or intravenous glucagon challenges.

Results: The patient was insulin resistant before surgery (glucose infusion 4.6 mg · kg-1 · min-1, normal range 6.4 ± 0.5 mg ·kg-1 · min-1). Insulin sensitivity declined further after transplantation (1.4 and 3.0 mg · kg-1 · min-1 after 4 weeks and 6 months, respectively), but improved to 5.4 mg · kg-1 · min-1 after 2 years. Insulin secretion was greatly impaired before surgery. Insulin and C-peptide responses after oral glucose and intravenous glucagon increased into the normal range from 6 months after surgery onwards and oral glucose tolerance remained non-diabetic (IGT).

Conclusions: Insulin resistance is first aggravated after pancreas transplantation, probably due to immunosuppressive treatment including glucocorticoids, but improves on the long term. The initially impaired insulin secretion from the transplant may also be explained by the action of glucocorticoids or by transient and reversible organ damage.

Key words:

Pancreas transplantation - Type 2 diabetes - Insulin secretion - Insulin resistance - Immunosuppression

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Prof. Dr. med. Michael A. Nauck

Diabeteszentrum Bad Lauterberg

Kirchberg 21

37431 Bad Lauterberg im Harz

Germany

Phone: + 49-5524-81218

Fax: + 49-5524-81398

Email: M.Nauck@diabeteszentrum.de