NDT Advance Access originally published online on August 8, 2007
Nephrology Dialysis Transplantation 2007 22(11):3358-3359; doi:10.1093/ndt/gfm519
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The effect of ciclosporin on insulin secretion and resistance
Correspondence and offprint requests to: Email: soypacaci{at}yahoo.comSir,
We read with great interest the article by Hjelmesaeth et al. [1], demonstrating short-term ciclosporin A (CsA) treatment on insulin secretion and insulin sensitivity. They showed that 2 weeks CsA treatment in haemodialysis patients impairs second phase insulin secretion at the doses of transplantation. However, they did not find any deleterious effect of CsA on insulin sensivity. In their study, hyperglycaemic glucose clamp method was used to evaluate insulin secretion profile and they also measured insulin sensitivity index (ISI), which was calculated as glucose disposal rate during the last 60 min of the procedure. However, it should be considered that hyperinsulinemic euglycaemic c2A0EE50lamp is the gold-standard method for estimation of insulin resistance and measurement of insulin action [2] (in this method, glucose disposal rate reflects the insulin resistance due to maximum suppression of the hepatic glucose output under the supraphysiological doses of insulin infusion). Hepatic glucose output is elevated in type 2 DM and insulin resistance, due to a decrease in hepatic insulin action. Therefore, in this study, while the choosen method is acceptable for the evaluation of insulin secretion, it is not sufficient to conclude and demonstrate whether short-term CsA is associated with insulin resistance or not. Both clamp methods could be more suitable for the analyses, as was previously demonstrated by DeFRonzo et al. [3] in uraemic patients.
Conflict of interest statement. None declared.
Department of Nephrology
Ankara University School of Medicine
Ibni Sina Hospital Ankara
Turkey
References
- Hjelmesaeth J, Hagen LT, Asberg A, et al. The impact of short-term ciclosporin A treatment on insulin secretion and insulin sensivity in man. Nephrol Dial Transplant (2007) 22:1743–1749.
[Abstract/Free Full Text] - DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique:a method for quantifying insulin secretion and resistance. Am J Physiol (1979) 3:214–223.
- DeFronzo RA, Tobin JD, Rowe JW, et al. Glucose intolerance in uremia. Quantification of pancreatic beta cell sensitivity to glucose and tissue sensitivity to insulin. J Clin Invest (1978) 2:425–435.
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