Utility of Glucagon Stimulation Test in Type 1 Diabetes After Pancreas Transplantation

Hayashi, Izumi; Suzuki, Atsushi; Kondo-Ando, Mizuho; Hikita, Hiroyuki; Maeda, Yasuo; Sekiguchi-Ueda, Sahoko; Shibata, Megumi; Takayanagi, Tetsuya; Makino, Mitsuhiro; Fukami, Naohiko; Itoh, Taiki; Sasaki, Hideo; Kusaka, Mamoru; Kenmochi, Takashi; Hoshinaga, Kiyotaka; Itoh, Mari

doi:10.1016/j.transproceed.2013.11.027

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…We chose the results of GSCTs as the primary endpoint. Such tests have been validated over many decades as reflective of β‐cell function in people with type 2 as well as type 1 diabetes . The tests are relatively easy to perform, an advantage in a multicentre study in which the capacities for testing varied among the centres.…”

Section: Discussionmentioning

confidence: 99%

“…Such tests have been validated over many decades as reflective of β-cell function in people with type 2 as well as type 1 diabetes. 20,21 The tests are relatively easy to perform, an advantage in a multicentre study in which the capacities for testing varied among the centres. The tests were uniformly performed at normal or only slightly hyperglycaemic glucose levels; hence, a confounding influence of hypoglycaemia or marked hyperglycaemia on our measurements can be excluded.…”

Section: Discussionmentioning

confidence: 99%

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Investigating optimal β‐cell‐preserving treatment in latent autoimmune diabetes in adults: Results from a 21‐month randomized trial

Hals

Fleiner

Reimers

et al. 2019

Diabetes Obesity Metabolism

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Aims To compare outcomes of glucagon‐stimulated C‐peptide tests (GSCTs) in people with latent autoimmune diabetes in adults (LADA) after a 21‐month intervention with either insulin or the dipeptidyl peptidase‐4 inhibitor sitagliptin. Research design and methods We included 64 glutamic acid decarboxylase (GAD) antibody‐positive individuals, who were diagnosed with diabetes <3 years before the study, aged 30 to 70 years, and without clinical need for insulin treatment. We stratified participants by age and body mass index (BMI) and evaluated β‐cell function by GSCT after a 48‐hour temporary withdrawal of study medication. Results Age at randomization (mean 53 years), BMI (mean 27 kg/m2) and metabolic markers were similar between treatment arms. Glycated haemoglobin concentrations during intervention did not differ between arms. Fasting C‐peptide concentrations after the intervention were similar, as were stimulated C‐peptide levels (0.82 ± 0.63 nmol/L after insulin, 0.82 ± 0.46 nmol/L after sitagliptin; nonsignificant). Autoimmunity in the study population (estimated from GAD antibody titres and positivity/no positivity for zinc transporter 8 and islet antigen 2 antibodies) affected the evolution of the GSCT results significantly, which deteriorated in participants with high but not in those with low autoimmunity. Adjustment using analysis of covariance for the degree of autoimmunity did not alter the findings of no difference between treatment arms. Conclusions β‐cell function after intervention was similar in patients with insulin‐ and sitagliptin‐treated LADA, regardless of the strength of autoimmunity. Further, participants with low levels of GAD antibodies did not experience progressive deterioration of β‐cell function over a 21‐month period. Taken together, these findings could be useful for clinicians' choices of treatment in people with LADA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Investigating optimal β‐cell‐preserving treatment in latent autoimmune diabetes in adults: Results from a 21‐month randomized trial

Hals

Fleiner

Reimers

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…The outcomes of pancreas transplantation were evaluated by the following factors: pancreatic graft survival (serum C‐peptide > 0.3 ng/ml), insulin‐free status, hemodialysis‐free status, basal serum C‐peptide level at 1 month after transplantation, glucagon‐stimulated serum C‐peptide level and the time course of the HbA1C and s‐Cre levels. Glucagon stimulation tests were performed using the intravenous loading of 1 mg of glucagon at almost 1 month after transplantation . The serum samples were obtained at 0 and 6 min after the loading of Glucagon, and the ΔC‐pep was calculated based on the difference between these values.…”

Section: Methodsmentioning

confidence: 99%

Single institution outcomes in the first 3 years of pancreas transplantation from brain dead donors

Ito

Kenmochi

Ono

et al. 2016

J Hepato Biliary Pancreat

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“…We have also demonstrated that 72 h mean glucose measured by CGMS in PTX patients with normal oral glucose tolerance was associated with chronic rejection in a 5 year follow-up [37]. Recently, Hiratsuka et al have described the utility of peripheral plasma fasting serum C-peptide response to 1 mg of glucagon intravenously to predict insulin-free treatment [38]. However, further studies are warranted, since biochemical parameters and imaging tools still lack diagnostic accuracy to detect early graft failure, especially for PTA and PAK.…”

Section: Diabetes After Pancreas Transplantationmentioning

confidence: 99%

Diabetes and other endocrine-metabolic abnormalities in the long-term follow-up of pancreas transplantation

Lauria

Ribeiro‐Oliveira

2016

Clin Diabetes Endocrinol

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Pancreas transplantation (PTX) has been demonstrated to restore long-term glucose homeostasis beyond what can be achieved by intensive insulin therapy or islet transplants. Moreover, PTX has been shown to decrease the progression of the chronic complications of diabetes. However, PTX patients require chronic use of immunosuppressive drugs with potential side effects. The long-term follow-up of PTX patients demands special care regarding metabolic deviations, infectious complications, and chronic rejection. Diabetes and other endocrine metabolic abnormalities following transplantation are common and can increase morbidity and mortality. Previous recipient-related and donor-related factors, as well as other aspects inherent to the transplant, act together in the pathogenesis of those abnormalities. Early recognition of these disturbances is the key to timely treatment; however, adequate tools to achieve this goal are often lacking. In a way, the type of PTX procedure, whether simultaneous pancreas kidney or not, seems to differentially influence the evolution of endocrine and metabolic abnormalities. Further studies are needed to define the best approach for PTX patients. This review will focus on the most common endocrine metabolic disorders seen in the long-term management of PTX: diabetes mellitus, hyperlipidemia, and bone loss. The authors here cover each one of these endocrine topics by showing the evaluation as well as proper management in the follow-up after PTX.

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Utility of Glucagon Stimulation Test in Type 1 Diabetes After Pancreas Transplantation

Cited by 6 publications

References 9 publications

Investigating optimal β‐cell‐preserving treatment in latent autoimmune diabetes in adults: Results from a 21‐month randomized trial

Investigating optimal β‐cell‐preserving treatment in latent autoimmune diabetes in adults: Results from a 21‐month randomized trial

Single institution outcomes in the first 3 years of pancreas transplantation from brain dead donors

Diabetes and other endocrine-metabolic abnormalities in the long-term follow-up of pancreas transplantation

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