Impaired insulin response after oral but not intravenous glucose in heart- and liver-transplant recipients.

Details

Serval ID
serval:BIB_CF71F5AB7D0E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impaired insulin response after oral but not intravenous glucose in heart- and liver-transplant recipients.
Journal
Transplantation
Author(s)
Henchoz E., D'Alessio D.A., Gillet M., Halkic N., Matzinger O., Goy J.J., Chioléro R., Tappy L., Schneiter P.
ISSN
0041-1337 (Print)
ISSN-L
0041-1337
Publication state
Published
Issued date
2003
Volume
76
Number
6
Pages
923-929
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
BACKGROUND: The prevalence of diabetes is high after transplantation. We hypothesized that liver transplantation induces additional alterations of glucose homeostasis because of liver denervation.
METHODS: Nondiabetic patients with a heart (n=9) or liver (n=9) transplant and healthy subjects (n=8) were assessed using a two-step hyperglycemic clamp (7.5 and 10 mmol/L). Thereafter, an oral glucose load (0.65 g/kg fat free mass) was administered while glucose was clamped at 10 mmol/L. Glucose appearance from the gut was calculated as the difference between glucose appearance (6,6 2H2 glucose) and exogenous glucose infusion. Plasma insulin, glucagon-like peptide (GLP)-1 and gastric inhibitory polypeptide(GIP) concentrations were compared after intravenous and oral glucose.
RESULTS: After oral glucose, the glucose appearance from the gut was increased 52% and 81% in liver- and heart-transplant recipients (P<0.05). First-pass splanchnic glucose uptake was reduced by 39% in liver-transplant and 64% in heart-transplant patients (P<0.05). After oral but not intravenous glucose, there was an impairment of insulin secretion in both transplant groups relative to the controls. Plasma concentrations of GIP and GLP-1 increased similarly in all three groups after oral glucose.
CONCLUSIONS: First-pass hepatic glucose extraction is decreased after heart and liver transplant. Insulin secretion elicited by oral, but not intravenous glucose, is significantly reduced in both groups of patients. There was no difference between liver- and heart-transplant recipients, indicating that hepatic denervation was not involved. These data suggest an impairment in the beta-cell response to neural factors or incretin hormones secondary to immunosuppressive treatment.
Keywords
Administration, Oral, Adult, Blood Glucose/metabolism, Body Mass Index, Female, Glucose/administration & dosage, Glucose Clamp Technique/methods, Heart Transplantation/physiology, Humans, Infusions, Intravenous, Insulin/blood, Insulin/secretion, Liver Transplantation/physiology, Male, Reference Values
Pubmed
Web of science
Create date
24/01/2008 14:36
Last modification date
20/08/2019 16:49
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