Glucose Tolerance in Non-Diabetic Kidney Transplant Patients Before and 6 Months After Transplantation Compared to Healthy Controls.

Abstract

Purpose. Evaluating the effect of living kidney transplantation (Tx) on insulin sensitivity (IS) in non-diabetic uremic patients (ptt). Methods. Nine non-diabetic ptt awaiting Tx and six age and BMI matched healthy controls (Ctrl) examined with an oral glucose tolerance test before Tx. Furthermore, a 3 hour hyperinsulinaemic euglycaemic clamp was performed before and 6 months after Tx. Immunosuppression with simulect induction, cyclosporine (n=4)/prograf (n=5), MMF and steroids (one without steroids). Results. Fasting plasma glucose (FPG) (Tx: 5.1±0.7, Ctrl: 5.0±0.3 mmol/L) and HbA1c (Tx: 33±4, Ctrl: 33±2 mmol/mol) were comparable before Tx and HbA1c increased after Tx (FPG: 5.5±0,4 mmol/L (P=NS) and HbA1c: 35±3 mmol/mol (P=0.04)). All exept two Tx ptt with prediabetes had both normal FPG and normal glucose tolerance (mean 2h glucose Tx: 6.9±1.0 Ctrl: 5.5±1.5 mmol/L, P = 0.06). Insulin sensitivity measured as the total amount of glucose utilized during the clamp (GIR area under the curve) was lower in Tx patients before Tx (Tx: 490±164, Ctrl: 786±256 mg/kg, P = 0.02) and further reduced after Tx (319±131 mg/kg, P = 0.01).Figure: No Caption available.The weighted average of plasma glucose (AUC/180 min) during the clamp was comparable (Tx-before: 4.9±0.2 mmol/L Ctrl: 4.9±0.1 mmol/L and Tx-after: 5.1±0.2 mmol/L). Fasting insulin levels tended to be higher in Tx ptt (Tx: 62±34, Ctrl: 37±17 pmol/l, P = 0.2) and increased further after Tx (82±51 pmol/l, (P = 0.28)). Conclusion. Insulin sensitivity is impaired in non-diabetic Tx ptt as compared to healthy controls before Tx and IS deteriorates further after Tx. Uremia pre-Tx and immunosuppression post-Tx may contribute to this.