Nephrology Dialysis Transplantation, Vol 13, Issue 2 425-429, Copyright © 1998 by Oxford University Press
K Midtvedt, A Hartmann, , J th, K Lund and B Bjerkely
Background. Post-transplant diabetes mellitus is a
known complication of steroid therapy in renal transplant recipients. Both
insulin resistance and insulin deficiency have been shown to be necessary
for development of post-transplant diabetes mellitus. It is not known
whether recipients with impaired glucose tolerance have similar degree of
insulin resistance or deficient insulin response as recipients with
post-transplant diabetes mellitus. Methods. To address
this question, we used an oral glucose tolerance test to categorize 46
renal transplant recipients on triple immunosuppressive medication to
groups with normal glucose tolerance, impaired glucose tolerance or
post-transplant diabetes mellitus. Insulin sensitivity was measured using a
hyperinsulinaemic euglycaemic clamp. Insulin response was calculated from
the increase in serum insulin concentration during the oral glucose
tolerance test. Results. Twenty-five were categorized
to normal glucose tolerance, 15 to impaired glucose tolerance and six to
post-transplant diabetes mellitus. There were no statistically significant
differences between the groups regarding prednisolone dose, azathiprine
dose, use of {beta}-blocker, age, gender, weight, waist-hip ratio, body
mass index, donor source, smoking habits, or first-degree relatives with
histories of diabetes mellitus. The impaired glucose tolerance and
post-transplant diabetes mellitus groups showed a significant reduction in
insulin-stimulated glucose disposal rate (mg/kg.min)
compared to the normal glucose tolerance group (4.6±1.6 and
3.4±1.3 respectively vs 7.1±2.4,
P<0.05). The insulin response (picomol/l) was
not different between the normal glucose tolerance and impaired glucose
tolerance groups but was significantly reduced in the post-transplant
diabetes mellitus group (448±310 and 450±291
respectively vs 170±128,
P<0.05).Conclusion.
Insulin resistance is a common denominator of post-transplant
diabetes mellitus and impaired glucose tolerance in renal transplant
recipients. Keywords: glucose disposal rate;
hyperinsulinaemic euglycaemic clamp; impaired glucose tolerance; kidney;
transplantation; resistance; risk factor
ORIGINAL ARTICLES
Insulin resistance is a common denominator of post-transplant diabetes mellitus and impaired glucose tolerance in renal transplant recipients
Department of Internal Medicine, The National Hospital, University of Oslo, Norway; Corresponding author address: Section of Nephrology, Med. Dept. B III, Rikshospitalet, N-0027 Oslo, Norway
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