Battezzati A, Bonfatti D, Benedini S, Calori G, Caldara R, Mazzaferro V, Elli A, Secchi A, Di Carlo V, Pozza G, Luzi L
Department of Medicine, Istituto Scientifico San Raffaele, University of Milan, Milano, Italy.
Diabet Med. 1998 Dec;15(12):991-6. doi: 10.1002/(SICI)1096-9136(1998120)15:12<991::AID-DIA717>3.0.CO;2-Q.
Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP-Tx, n = 55), and isolated kidney or liver transplanted non-diabetic subjects on the same immunosuppressive regimen (CON-Tx, n = 14), underwent 1-day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP-Tx had lower PG than CON-Tx in the night and in the morning and higher insulin concentrations throughout the day. KP-Tx had lower PG nadirs than CON-Tx (4.40+/-0.05 vs 4.96+/-0.16 mmol l(-1), ANOVA p = 0.001). Nine per cent of KP-Tx had hypoglycaemic values (PG < or = 3.0 mmol l(-1)) in the profiles, both postprandial and postabsorptive, whereas none of CON-Tx did (p < 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia.
低血糖是1型糖尿病（DM）胰岛素治疗的重要并发症。胰腺移植将葡萄糖感知与胰岛素分泌相结合，相对于胰岛素治疗具有显著优势。我们测试了成功移植是否能避免1型糖尿病患者发生低血糖。符合良好功能标准的联合肾脏和胰腺移植的1型糖尿病患者（KP-Tx，n = 55），以及接受相同免疫抑制方案的孤立肾或肝移植的非糖尿病受试者（CON-Tx，n = 14），在移植后的前3年进行了为期1天的代谢谱分析，每2小时采集血浆葡萄糖（PG）和胰腺激素样本。KP-Tx在夜间和早晨的PG低于CON-Tx，且全天胰岛素浓度更高。KP-Tx的PG最低点低于CON-Tx（4.40±0.05 vs 4.96±0.16 mmol l(-1)，方差分析p = 0.001）。在代谢谱分析中，9%的KP-Tx在餐后和吸收后出现低血糖值（PG≤3.0 mmol l(-1)），而CON-Tx均未出现（p < 0.02）。总之，胰腺移植后，轻度低血糖很常见，但其临床影响有限。与1型糖尿病的胰岛素治疗相比，胰腺移植可改善但不能消除低血糖。
