Original Data

Results of Pancreas Transplantation Alone with Special Attention to Native Kidney Function and Proteinuria in Type 1 Diabetes Patients

Ugo Boggi¹, Fabio Vistoli¹, Gabriella Amorese¹, Rosa Giannarelli², Alberto Coppelli², Rita Mariotti³, Lorenzo Rondinini³, Massimiliamo Barsotti⁴, Alberto Piaggesi², Anna Tedeschi², Stefano Signori¹, Nelide De Lio¹, Margherita Occhipinti², Emanuela Mangione², Diego Cantarovich⁴, Stefano Del Prato², Franco Mosca⁵, Piero Marchetti^2,6

Abstract

We report on our single-center experience with pancreas transplantation alone (PTA) in 71 patients with type 1 diabetes, and a 4-year follow-up. Portal insulin delivery was used in 73.2% of cases and enteric drainage of exocrine secretion in 100%. Immunosuppression consisted of basiliximab (76%), or thymoglobulin (24%), followed by mycophenolate mofetil, tacrolimus, and low-dose steroids. Actuarial patient and pancreas survival at 4 years were 98.4% and 76.7%, respectively. Relaparatomy was needed in 18.3% of patients. Restored endogenous insulin secretion resulted in sustained normalization of fasting plasma glucose levels and HbA1c concentration in all technically successful transplantations. Protenuria (24-hour) improved significantly after PTA. Renal function declined only in recipients with pretransplant glomerular filtration rate (GFR) greater than 90 ml/min, possibly as a result of correction of hyperfiltration following normalization of glucose metabolism. Further improvements were recorded in several cardiovascular risk factors, retinopathy, and neuropathy. We conclude that PTA was an effective and reasonably safe procedure in this single-center experience.

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Esophageal Dysmotility is More Common Than Gastroparesis in Diabetes Mellitus and is Associated With Retinopathy

Rita J. Gustafsson¹, Bengt Littorin², Kerstin Berntorp³, Anders Frid³, Ola Thorsson⁴, Rolf Olsson⁵, Olle Ekberg⁵, Bodil Ohlsson¹

Abstract

OBJECTIVES: Gastroparesis is a well-known complication of diabetes mellitus, both in symptomatic and asymptomatic patients. Esophageal dysmotility has also been described, but is not as well-characterized. The etiology and effect of these complications need to be clarified. The aim of the present study was to evaluate esophageal and gastric motility, complications, gastrointestinal symptoms, and plasma biomarkers in a cross-sectional study comprising patients with diabetes mellitus. METHODS: Patients with diabetes were consecutively asked to participate, and eventually 84 volunteers were included in the study. Esophageal manometry and the gastric emptying test were performed in all patients. Type of diabetes, symptoms, diabetic complications, body mass index (BMI), and biomarkers were recorded. Patients were interviewed about gastrointestinal symptoms. RESULTS: Esophageal dysmotility was present in 63% of patients and gastroparesis in 13% of patients. There was no difference in dysmotility between patients with type 1 and type 2 diabetes or between genders. Gastrointestinal symptoms did not correlate to objective findings. Age correlated negatively with gastric emptying rate (p = 0.004). Patients with esophageal dysmotility had longer duration of diabetes compared to those without dysmotility (p = 0.043). In logistic regression analysis, retinopathy was strongly associated with esophageal dysmotility, independent of duration (p = 0.003). CONCLUSIONS: Esophageal dysmotility is more common than gastroparesis in diabetes mellitus independent of gender, symptoms, and type of diabetes. There is a strong association between retinopathy and esophageal dysmotility.

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The Frequency of Prediabetes and Contributing Factors in Patients with Chronic Kidney Disease

Effat Razeghi¹, Peimaneh Heydarian², Mahshid Heydari¹

Abstract

AIMS: Uremia is a prediabetic state, but abnormal glucose metabolism and relative risk factors in non-diabetic chronic kidney disease (CKD) patients are not studied extensively. This study aimed to evaluate prediabetes and contributing factors in patients with CKD. METHODS: We studied the frequency of prediabetes (defined as fasting plasma glucose 100-125 mg/dl and 2-h plasma glucose 140-199 mg/dl) and contributing risk factors in 91 (34 women and 57 men) non-diabetic CKD (GFR < 60) patients who were referred to Sina Hospital between November 2010 and November 2011. Impaired fasting glucose and impaired glucose tolerance were regarded as prediabetic state. RESULTS: Thirty-eight patients (41.8%), 28 male and 10 female, with mean age of 57.4 ± 17.1 yr, had prediabetes. Among these, 18.7% had impaired fasting glucose, 7.7% impaired glucose tolerance, and 15.4% combined impaired fasting glucose and impaired glucose tolerance. CKD patients with impaired glucose tolerance had more frequently hypertriglyceridemia (85.7% vs. 42.0%, p = 0.001), hypertension (66.6% vs. 31.4%, p = 0.004), and metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III (52.3% vs. 25.7%, p = 0.02). Also, mean systolic blood pressure (134.2 ± 13.9 vs. 124.5 ± 20.0, p = 0.004) was higher in CKD patients with impaired glucose tolerance compared to CKD patients with normal glucose. CONCLUSIONS: Prediabetes is a frequent condition in CKD patients. Also, hypertriglyceridemia and hypertension are more prevalent in prediabetic CKD patients than in non-diabetic CKD patients.

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