Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
Endocr J. 2019 Dec 25;66(12):1101-1112. doi: 10.1507/endocrj.EJ19-0180. Epub 2019 Sep 7.
Pancreas transplantation (PTx) has been performed worldwide for patients with type 1 diabetes accompanied with end-stage renal disease or uncontrollable glycemic fluctuation. Nevertheless, risk factors of posttransplant glucose intolerance, which is responsible for progress of diabetic complications, remains unclear, especially in cases without pancreatic graft function loss. Therefore, this study was conducted to search for predictive factors of future glucose tolerance in PTx recipients without pancreatic graft function loss. Subjects were selected from among 41 Japanese patients with type 1 diabetes who received PTx between 2000 and 2016 in Osaka University Hospital, and 24 subjects free from rejections and thromboses were analyzed. Several examinations to evaluate insulin secretion and insulin sensitivity within 6 months after transplantation (initial examination) were performed. Glucose tolerance was evaluated by 120-minute post-load plasma glucose level during 75-g oral glucose tolerance tests (OGTT), referred to as PG120, at the initial examination and between 1 year and 2 years posttransplantation (maintenance period). The initial examination factors that were correlated with PG120 in the maintenance period were PG120 [r = 0.52 (p = 0.01)], insulinogenic index [r = -0.65 (p < 0.01)], and the ratio of incremental area under the curve of insulin to that of plasma glucose (iAUCR) calculated from data of OGTT [r = -0.65 (p < 0.01)]. Insulinogenic index [β = -0.28 (p = 0.02)] and iAUCR [β = -0.29 (p = 0.02)] were still significantly correlated with PG120 in the maintenance period after adjustment for PG120 at the initial examination. In conclusion, insulinogenic index and iAUCR from OGTT performed in the early posttransplantation period were predictive factors of future glucose intolerance.
胰腺移植（PTx）已在全球范围内为患有 1 型糖尿病伴终末期肾病或血糖波动不可控的患者进行。然而，导致糖尿病并发症进展的移植后葡萄糖耐量受损的危险因素仍不清楚，特别是在没有胰腺移植物功能丧失的情况下。因此，本研究旨在寻找无胰腺移植物功能丧失的 PTx 受者未来葡萄糖耐量的预测因素。该研究从大阪大学医院 2000 年至 2016 年间接受 PTx 的 41 例 1 型糖尿病日本患者中选择了研究对象，分析了 24 例无排斥和血栓形成的患者。在移植后 6 个月内进行了几项评估胰岛素分泌和胰岛素敏感性的检查（初始检查）。通过 75g 口服葡萄糖耐量试验（OGTT）的 120 分钟餐后血浆葡萄糖水平（PG120）评估葡萄糖耐量，在初始检查和移植后 1 年至 2 年期间（维持期）评估 PG120。在维持期，与 PG120 相关的初始检查因素为 PG120[r=0.52（p=0.01）]、胰岛素原指数[r=-0.65（p<0.01）]和 OGTT 数据计算的胰岛素与血糖增量面积比（iAUCR）[r=-0.65（p<0.01）]。调整初始检查时的 PG120 后，胰岛素原指数[β=-0.28（p=0.02）]和 iAUCR[β=-0.29（p=0.02）]仍与维持期的 PG120 显著相关。总之，移植后早期 OGTT 中的胰岛素原指数和 iAUCR 是未来葡萄糖耐量受损的预测因素。
