Neuropathy and mortality in diabetes: Influence of pancreas transplantation

Abstract

We collected information on patient status and cause of death for 545 insulin‐dependent diabetic subjects who had cardiorespiratory reflex and nerve conduction tests performed to determine if presence and severity of autonomic and somatic neuropathy is associated with mortality and if a functioning pancreas transplantation (PTx) influences mortality. Follow‐up was 12–138 months. Abnormal cardiorespiratory reflexes were present in 417 patients and there was abnormal nerve conduction in 392 patients. Mortality rates for patients with abnormal tests were higher (P < 0.0001) than for patients with normal tests. A total neuropathy score that included cardiorespiratory and nerve conduction test scores predicted survival better than separate scores. Patients with moderate neuropathy, but not those with severe neuropathy, who retained a functioning PTx, had longer survival times than patients whose PTx failed in the first 3 months. Considering only patients transplanted after 1985, those with moderate neuropathy who retained a functioning PTx had even longer survival times than nontransplanted patients. © 1996 John Wiley & Sons, Inc.

Pulmonary Function in Patients With Type 1 Diabetes Before and After Simultaneous Pancreas and Kidney Transplantation

“…Possible glucose-related causes of pulmonary dysfunction such as autonomic neuropathy or pulmonary macroangiopathy are hardly reversible. On the other hand an improvement of autonomic neuropathy has been shown after SPK (30). The importance of glucose metabolism on pulmonary function is also known in patients with cystic fibrosis.…”

Pathophysiology and Treatment of Diabetic Peripheral Neuropathy: The Case for Diabetic Neurovascular Function as an Essential Component

“…Therefore treatment of neuropathy should include measures to reduce risk factors: hyperglycemia, blood pressure and lipid control and lifestyle modifications (exercise, weight reduction, smoking cessation, balanced diet and avoidance of excess alcohol consumption). Reducing risk factors is the first line of therapy, however studies suggest that even with glycaemic control, nerve damage occurs, and the ability to reverse established neuropathy with glycaemic control in pancreatic transplantation has had only moderate success [182][183][184]. Clearly, there is a need for interventions beyond glycaemic control [48,161].…”

The Long-term Management of Pancreas Transplantation

“…Both autonomic function and NCS were significantly improved in the patients who lived 10 years as opposed to those that died. This survival advantage is consistent with other studies (118,120,121). Early treatment of orthostatic hypotension in SPK with midodrine shortly after transplant provided improvement in symptoms (122).…”