Effects of Pancreas Transplantation on Metabolic and Hormonal Profiles in IDDM Patients

The diurnal patterns of relevant metabolites and hormones in five pancreas-kidney-transplanted patients (aged 36 ± 2 yr, mean ± SD) with insulindependent diabetes mellitus (IDDM) were compared with those in five kidney-transplanted nondiabetic patients (aged 28 ± 2 yr). The groups were matched for body mass and current dose and type of immunosuppressive treatment. The serum creatinine levels did not differ between the two study groups, but the serum urea level in the nondiabetic patients was slightly but significantly higher than in the diabetic patients. In the pancreas-kidney-transplanted group the investigation was performed 8–47 mo posttransplantation; in the kidney-transplanted nondiabetic patients, 12–18 mo posttransplantation. The mean 24-h levels and rhythms of blood glucose, free fatty acid, 3-hydroxybutyrate, and alanine did not differ between the groups. The mean 24-h levels of blood lactate and glycerol were moderately but significantly higher in the pancreas-kidneytransplanted diabetic patients. At fasting, the level of serum immunoreactive insulin was more than twice as high in the pancreas-kidney-transplanted patients, whereas the plasma C-peptide levels did not differ significantly between the two groups. The mealinduced increases in serum insulin as well as in the plasma C-peptide levels were more marked in the pancreas-kidney-transplanted patients. The findings suggest that the hyperinsulinemia in these patients was due to both the systemic delivery of insulin and an increase in insulin resistance, the latter being particularly apparent in the postprandial phase. In the pancreas-kidney-transplanted patients, elevated plasma glucagon levels were also observed, whereas the mean 24-h level and number of peaks of growth hormone did not differ significantly between the two study groups.